Combination therapy with gefitinib and rofecoxib in patients with platinum-pretreated relapsed non-small-cell lung cancer

Purpose In non-small-cell lung cancer ( NSCLC), the epidermal growth factor receptor ( EGFR) and cyclooxygenase-2 ( COX-2) play major roles in tumorigenesis. This phase I/ II study evaluated combined therapy with the EGFR tyrosine kinase inhibitor ( TKI) gefitinib and the COX-2 inhibitor rofecoxib in platinum-pretreated, relapsed, metastatic NSCLC ( n = 45). Patients and Methods Gefitinib 250 mg/ d was combined with rofecoxib ( dose escalated from 12.5 to 25 to 50 mg/ d through three cohorts, each n = 6). Because the rofecoxib maximum-tolerated dose was not reached, the 50 mg/ d cohort was expanded for efficacy evaluation ( n = 33). Results Among the 42 assessable patients, there was one complete response ( CR) and two partial responses ( PRs) and 12 patients with stable disease ( SD); disease control rate was 35.7% ( 95% Cl, 21.6% to 52.0%). Median time to tumor progression was 55 days ( 95% Cl, 47 to 70 days), and median survival was 144 days ( 95% Cl, 103 to 190 days). In a pilot study, matrix-assisted laser desorption/ ionization ( MALDI) proteomics analysis of baseline serum samples could distinguish patients with an objective response from those with SD or progressive disease ( PD), and those with disease control ( CR, PR, and SD) from those with PD. The regimen was generally well tolerated, with predictable toxicities including skin rash and diarrhea. Conclusion Gefitinib combined with rofecoxib provided disease control equivalent to that expected with single-agent gefitinib and was generally well tolerated. Baseline serum proteomics may help identify those patients most likely to benefit from EGFR TKIs.