1. ¹Oncopharmacology Unit, Centre Antoine-Lacassagne, 33 Avenue de Valombrose, Nice 06189, France
2. ²Medical Oncology Department, Hôpital Pitié Salpétrière, AP-HP, 47-83 Boulevard de l'Hôpital, Paris 75651, France
3. ³Winship Cancer Institute, Emory University School of Medicine, 1365-C Clifton Road, Suite 40141, Atlanta, GA 30322, USA

Correspondence: Dr G Milano, E-mail: gerard.milano@nice.fnclcc.fr

Received 21 November 2007; Revised 2 April 2008; Accepted 9 April 2008; Published online 27 May 2008.

Abstract

The clinical experience recently reported with epidermal growth factor receptor (EGFR)-targeting drugs confirms the synergistic interactions observed between these compounds and conventional cytotoxic agents, which were previously established at the preclinical stage. There are, however, examples of major gaps between the bench and the bedside. Particularly demonstrative is the failure of the tyrosine kinase inhibitors (TKIs) (gefitinib and erlotinib) combined with chemotherapy in pretreated nonsmall cell lung cancer patients. These discrepancies can be due to several factors such as the methodology used to evaluate TKI plus cytotoxic agent combinations in preclinical models and the insufficient consideration given to the importance of the drug sequences for the tested combinations. Recent advances in understanding the biologic basis of acquired resistance to these agents have great potential to improve their clinical effectiveness. The purpose of this review is to critically examine the experimental conditions of the preclinical background for anti-EGFR drug–cytotoxic agent combinations and to attempt to explain the gap between clinical observations and preclinical data.