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Intrapatient dose escalation of erlotinib does not appreciably increase the propensity to experience a maximal level of tolerable skin toxicity, or appear to increase the anticancer activity of erlotinib in NSCLC.
In the initial stage, we assessed the feasibility of intrapatient dose escalation from 150 mg per day to a maximal level of tolerable skin toxicity, which was defined as the TR.
The present trial was designed to assess the feasibility of intrapatient erlotinib dose escalation to achieve a maximal level of tolerable skin toxicity and to evaluate the anticancer activity, pharmacokinetics (PK), and pharmacodynamic (PD) markers associated with erlotinib treatment at these increased doses.
To evaluate the anticancer activity of erlotinib in patients with previously treated, advanced non-small cell lung cancer (NSCLC) whose dose is increased to that associated with a maximal level of tolerable skin toxicity (i.e., target rash (TR)); to characterise the pharmacokinetics (PK) and pharmacodynamics (PD) of higher doses of erlotinib.
Since most patients with advanced NSCLC who are treated with erlotinib at its recommended dose of 150 mg per day do not experience dose-limiting skin toxicity (Hidalgo et al, 2001), it was reasoned that increasing the dose of erlotinib to that associated with maximal level of tolerable skin toxicity (i.e., a target rash (TR)) might increase the likelihood of observing anticancer activity.
This study demonstrated that the dose escalation of erlotinib above its recommended dose of 150 mg per day to a maximal level of tolerable skin toxicity is feasible but does not seem to result in increased antitumour activity in this patient population (Shepherd et al, 2005; Ardavanis et al, 2008; Felip et al, 2008; Hesketh et al, 2008; Spiegel et al, 2008; Tiseo et al, 2009).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com