Pharmacy practice issues with targeted therapy for lung cancer.

Drug costs and reimbursement issues for targeted therapies for lung cancer and how they affect pharmacy practice are discussed. Lung cancer is the most frequent cause of cancer death in the western world. Despite improvements in treatment results, less than 15% of patients survive five years after their primary diagnosis. Major advances in the understanding of cancer biology have led to the identification of several potential targets for cancer treatment. In non-small cell lung cancer (NSCLC) one of the most promising new targets has been the epidermal growth factor receptor (EGFR), which is overexpressed in most squamous cell subtypes and > or = 65% of adenocarcinomas and large cell subtypes. Gefitinib is an orally available small-molecule tyrosine kinase inhibitor that targets the intracellular domain of the EGFR. It has demonstrated activity and tolerable toxicity in patients with NSCLC. Because of its daily oral route of administration, patient compliance and education are of paramount importance, and the pharmacist plays an increasingly important role in patient management.