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Impressive advances in genome analysis have made it possible to develop a new class of cancer drugs. These medicines act specifically on sites of impaired information transfer within cancer cells, and therefore, these substances are also called ‘targeted drugs’.

Which Targeted Medicines are available?

At present, two groups of targeted drugs are in clinical use, with monoclonal antibodies belonging in the first group. Monoclonal antibodies are drugs which resemble protein of the body’s own immune defence system. They act specifically on receptor molecules (receptors) located on the surface of cancer cells or binde specific proteins circulation in the blood. Monoclonal antibodies are administered by infusion.

The second group of medicines comprise drugs which specifically block the information transfer in cancer cells through enzymes.  As enzymes are mainly of kinase origin, these drugs are also called kinase inhibitors. These medicines are very small molecules and can be given as tablets. Due to their size, these drugs are also just called ‘small molecules’.

At present, monoclonal antibodies as well as ‚small molecules‘ are being tested in many malignant diseases, and some of these drugs are already approved, under defined guidelines, for use in cancer medicine in Europe, i.e. they can be obtained from a pharmacy on prescription. A large number of these drugs are currently being tested in clinical studies.

Which specific drugs are used in the treatment of lung cancer?

Currently the following three drugs are mainly used in the treatment of lung cancer :

• Bevacizumab (brand name Avastin) is a monoclonal antibody which specifically hinders the formation of blood vessels in the tumour and metastases. In addition, this antibody achieves  increased vessel permeability and therefore improves the effectiveness of chemotherapy. Bevacizumab is approved for the treatment of non-small cell lung carcinoma (NSCLC)and research has shown that the effectiveness of standard chemotherapy is improved by additional doses of Avastin. However, Avastin is only allowed for treatment in a subgroup  of NSCLC, the adenocarcinoma. The antibody is administered as an infusion on the same day as the chemotherapy. The drug is continued after the completion of the chemotherapy cycle until  such time as further disease progression is evident. Usually, the antibody is tolerated quite well and your oncologist will explain in detail all possible side effects. A common adverse effect, for example, is the development of high blood pressure (hypertension) and therefore careful and regular blood pressure checks before and during the treatment with Avastin are mandatory. Where appropriate, issues with blood pressure must be treated with drugs by your doctor.
• Erlotinib (brand name Tarceva) is a small molecule. It is a tyrosine kinase inhibitor, as already described, which acts on an important receptor responsible for growth, the EGF-receptor of the lung cancer cell. The acronym is derived from the term ‘epidermal growth factor’ receptor or EGFR. This drug is given as a tablet (one per day). In Germany, Erlotinib is approved for recurrent disease and is not administered in combination with chemotherapy. However, in exceptional cases Erlotinib can be used as first-line treatment. As with all drug treatments, side effects are possible and your oncologist will explain these in detail to you. One known side effect of Erlotinib is a skin condition similar to acne which may affect the entire body but can be treated. Depending on the severity of the condition, your doctor will prescribe ointments or occasionally tablets.
• Cetuximab (brandname Erbitux)is monoclonal antibody which also acts on the EGF-receptor of the surface of cancerous lung cells. Cetuximab is administered together with a standard chemotherapy in first-line treatment. The side effects are similar to that of Tarceva, i.e. acne-like skin condition.  Your doctor will assist you should you develop this condition.    

Additional targeted drugs are being tested in the Centre for Integrated Oncology as part of clinical studies. Your treating doctor will discuss with you the participation in  a clinical trial as well as explain to you all the advantages and disadvantages of doing so.  

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