Biological therapy for lung cancer

Biological therapies are treatments that use natural substances from the body, or that change the way cells signal to each other. They can stimulate the body to attack or control the growth of cancer cells. Several types of biological therapy are now used to treat advanced lung cancer. They include erlotinib (Tarceva), gefitinib (Iressa), cetuximab (Erbitux), and bevacizumab (Avastin). Research is also looking at using some biological therapies to treat earlier stages of lung cancer.

Erlotinib is also known by its brand name, Tarceva (tar-see-vah). You take it as a tablet. Erlotinib works by blocking epidermal growth factor receptors (EGFR) on cells. So your cancer cells will be checked to see if they have EGF receptors before you have this treatment. Cancers that have EGF receptors on their cells are called EGFR positive.

Erlotinib is used to treat patients with advanced non small cell lung cancer that has continued to grow despite having chemotherapy. Or as an alternative to docetaxel chemotherapy for people who have already had one course of chemotherapy that hasn't worked. 

Researchers are looking at whether erlotinib could be better than chemotherapy as a first treatment to control advanced non small cell lung cancer that is EGFR positive. A European trial called EURTAC compared erlotinib as a first treatment with chemotherapy which contained a platinum drug. This trial was for people with newly diagnosed advanced non small cell lung cancer with EGRF positive tumours. The researchers found that the time it took before the cancer started growing again for the people who took erlotinib was just over 9.5 months compared to just over 5 months for those having chemotherapy. Another trial called OPTIMAL also compared erlotinib with chemotherapy in Chinese patients who had EGFR positive tumours found similar results. Following these trials the Scottish Medicines Consortium (SMC) have said that erlotinib should be available within the NHS in Scotland as first line treatment for people with advanced EGFR positive non small cell lung cancer. The National Institute for Health and Clinical Excellence will make a decision later in 2012 about whether it should be available within the NHS in England.

The Scottish Medicines Consortium (SMC) have said erlotinib should not be available as maintenance treatment after chemotherapy for people with advanced lung cancer within the NHS in Scotland. They say it is not cost effective.

Erlotinib is not currently used as standard treatment for early stage non small cell lung cancer (NSCLC) but trials are looking at whether erlotinib can reduce the chance of NSCLC coming back after surgery. Trials are also looking at whether erlotinib with radiotherapy to the head can reduce the chance of lung cancer spreading to the brain. Some trials are combining erlotinib with chemotherapy or other biological therapy drugs. You can find out more about research into erlotinib for lung cancer on our lung cancer research page.

Gefitinib is also called Iressa or ZD 1839. It is a type of tyrosine kinase inhibitor (TKI). The National Institute for Health and Clinical Excellence (NICE) have recommended it as a first treatment for non small cell lung cancer that is locally advanced or has spread. To have gefitinib, people must test positive for a faulty gene (mutation) in a growth factor receptor that the drug acts on. The receptor is called epidermal growth factor receptor tyrosine kinase (EGFR-TK). 

NICE say that between 10 and 15 people out of every 100 with non small cell lung cancer (10 to 15%) have the EGR-TK mutation. In December 2010, after reassessing gefitinib the Scottish Medicines Consortium (SMC) decided not to recommend gefitinib for use within the NHS in Scotland. They say it is not cost effective.

A recent meta analysis of trials comparing gefitinib with chemotherapy as a first treatment for people with advanced cancer found that there was no difference in how long people lived for but that there was a difference in the side effects. People who had gefitinib had less tiredness, sickness and effects on the blood cells. They did have more skin problems (rash), diarrhoea and irritation of the lung. They also had a higher quality of life compared to those having chemotherapy.

Cetuximab is a monoclonal antibody which blocks growth factor receptors on cells. It has been used, with chemotherapy, in trials for advanced non small cell lung cancer. The results so far have been quite encouraging, in terms of helping people to live longer. Research is continuing to try to find the best way of using cetuximab.

Bevacizumab (also called Avastin) is a monoclonal antibody (MAB) that stops cancer cells making the blood vessels they need so that they can grow. In August 2007, bevacizumab was licensed in Europe to treat advanced non small cell lung cancer in combination with platinum based chemotherapy, such as cisplatin or carboplatin. This treatment has not been approved by the National Institute for Health and Clinical Excellence (NICE) and so is not used as a standard treatment on the NHS in the UK.

A recently published American study found that adding bevacizumab to carboplatin and paclitaxel chemotherapy didn't work any better than the chemotherapy alone. This study was looking at people who were over the age of 65 years with stage 3B or stage 4 non small cell lung cancer. 

The side effects vary depending on which drug you have. But the possible side effects of biological therapies for lung cancer include

• Tiredness (fatigue)
• Diarrhoea
• Skin changes (rashes or discolouration) – rashes may be severe for some people
• A sore mouth
• Weakness
• Loss of appetite
• Low blood counts
• Swelling of parts of the body, due to build up of fluid

Tell your doctor or nurse if you have any of these effects as you can have medicines to help to control them. There is information about the side effects of individual biological therapies in our cancer drugs section.

You can find detailed information in the biological therapy section of CancerHelp UK. You can ask your doctor or specialist nurse to write down the names of your drugs so you can look them up in the cancer drugs section. Our lung cancer organisations page gives details of people who can give information about lung cancer biological therapies. Some organisations can put you in touch with a cancer support group. Our lung cancer reading list has information about books and leaflets on lung cancer treatments.