The epidermal growth factor receptor (EGFR) is a key regulator of growth, differentiation, and survival of epithelial cancers. In a small subset of tumors, the presence of activating mutations within the ATP binding site confers increased susceptibility to gefitinib, a potent tyrosine kinase inhibitor of EGFR. Agents that can inhibit EGFR function through different mechanisms may enhance gefitinib activity in patients lacking these mutations. Mevalonate metabolites play significant roles in the function of the EGFR; therefore, mevalonate pathway inhibitors may potentiate EGFR-targeted therapies. Targeting HMG-CoA reductase, the rate-limiting enzyme of mevalonate pathway, using lovastatin induces a potent apoptosis in a variety of tumor types. In an in vitro study, combining gefitinib and lovastatin treatment showed synergistic cytotoxic activity through enhanced inhibition of AKT activation by EGF in NSCLC and head \& neck cancer cell lines. Therefore, the investigators would like to compare the combination effect of gefitinib and simvastatin, the specific and protein inhibitor of HMG-CoA reductase, with gefitinib alone in previously treated patients with NSCLC.
Randomization 1. Sex (female vs. male) 2. ECOG PS (0/1 vs. 2/3) 3. Number of prior regimen (one vs. two). Gefitinib (250 mg per day) + Simvastatin (40 mg per day) PO or Gefitinib (250 mg per day) alone until progression or unacceptable toxicity
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
110
Simvastatin 40mg/QD po daily every 3 weeks
gefitinib 250mg/QD po daily every 3 weeks
National Cancer Center, Korea
Goyang-si, Gyeonggi-do, South Korea
Overall Response rate
from C1D1 until confirmed disease progression
Time frame: every 8 weeks
Overall survival
the first day of treatment to death
Time frame: every 12 weeks
Toxicity
From C1D1 to 1 months after the last dose adminitration
Time frame: every 4 weeks
Pharmacogenetic and biomarker profile analysis
From screening visit until confirmed disease progression
Time frame: every 8 weeks
Time to progression
From randomization date to disease progresssion or death date
Time frame: every 8 weeks
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