ZD1839 (Iressa): what's in it for the patient?

Although cytotoxic chemotherapy has had a significant impact on the treatment of some malignancies, its impact against most solid tumors is limited. This is especially true in the case of non-small cell lung cancer (NSCLC) in which about 90% of patients ultimately die from metastatic disease. Although chemotherapy has produced modest improvements in response rates and survival in a subset of patients with advanced NSCLC, its primary objective remains to provide palliation of disabling disease-related symptoms. It is hoped that the introduction of new, rationally designed anticancer agents, with greater specificity and less toxicity, will improve the outcome for patients with a range of tumor types, including NSCLC. ZD1839 (Iressa) is the first of a new class of epidermal growth factor receptor tyrosine kinase inhibitors. The results of two large phase II trials have shown that ZD1839 provides clinically significant symptom relief for many patients with extensively pretreated advanced NSCLC. Moreover, this improvement in disease-related symptoms correlated with improved survival and tumor response. ZD1839 also had an acceptable tolerability profile: most drug-related adverse events were mild and reversible and quite different from those typically associated with cytotoxic agents. Some patients also experienced improved quality of life, particularly those with a partial response or stable disease. Thus, ZD1839 offers a new treatment option providing meaningful symptom relief for many patients with advanced NSCLC.