Relief of symptoms after gefitinib is associated with improvement of rest/activity rhythm in advanced lung cancer

Weread with interest the article by Bezjak et al1 on the clinical benefits induced by erlotinib treatment in patients with advanced non–small-cell lung cancer(NSCLC)progressing after prior chemotherapy. The authors report that patients receiving erlotinib had significantly longer median time to deterioration of dysphnea, cough, and pain as compared with placebo controls. Interestingly, quality of life (QOL) improvement was observed in approximately 22% of patients with progressive disease. These results substantially confirm those of the Iressa Dose Evaluation for Advanced Lung Cancer (IDEAL 1 and IDEAL 2) trials of single agent gefitinib in pretreated patients with NSCLC, where symptom improvement was found in approximately 40% of the patients whereas objective responses were observed in 12% to 18%.2 The reported discordance between tumor response and QOL improvement raises the possibility that epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors may exert their effects not only on tumor, but also on the host.