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Evolutions in the Treatment of EGFR-Mutated NSCLC

Insights From: Sai-Hong Ignatius Ou, MD, PhD, University of California, Irvine School of Medicine
Published: Tuesday, Jun 04, 2019



Transcript: 

Sai-Hong Ignatius Ou, MD, PhD: I cannot predict the future, but we can see incremental improvement in the progression-free survival by combining something with osimertinib. There are studies that combine anti-angiogenic agents with osimertinib. There are studies that combine chemotherapy with osimertinib. There are studies that combine EGFR antibodies with osimertinib. So, the future is likely based on using something with osimertinib. The platform is osimertinib with the addition of something. I do believe that chemotherapy with osimertinib is a very attractive option, based on the NEJ009 studies, with the addition of carboplatin and pemetrexed to gefitinib, which improves overall survival compared to gefitinib alone. I think chemotherapy with an upfront use of osimertinib can knock off some of the tumor cells that do not harbor the EGFR mutations. This is because in the big tumor, not all the tumor cells harbor EGFR mutations.

For those tumors that do not harbor EGFR mutations, chemotherapy can kill those cells. You may have a better overall response rate, a better and a deeper depth of response, which translates to a slower time to progression and a prolonged progression-free survival. I’m hopeful that chemotherapy with osimertinib may be the future. But other targeted agents can also do the same thing, and we have to wait. But to me, the platform is still osimertinib plus something else. Which something else? We don’t know. Time will tell.

Transcript Edited for Clarity
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Transcript: 

Sai-Hong Ignatius Ou, MD, PhD: I cannot predict the future, but we can see incremental improvement in the progression-free survival by combining something with osimertinib. There are studies that combine anti-angiogenic agents with osimertinib. There are studies that combine chemotherapy with osimertinib. There are studies that combine EGFR antibodies with osimertinib. So, the future is likely based on using something with osimertinib. The platform is osimertinib with the addition of something. I do believe that chemotherapy with osimertinib is a very attractive option, based on the NEJ009 studies, with the addition of carboplatin and pemetrexed to gefitinib, which improves overall survival compared to gefitinib alone. I think chemotherapy with an upfront use of osimertinib can knock off some of the tumor cells that do not harbor the EGFR mutations. This is because in the big tumor, not all the tumor cells harbor EGFR mutations.

For those tumors that do not harbor EGFR mutations, chemotherapy can kill those cells. You may have a better overall response rate, a better and a deeper depth of response, which translates to a slower time to progression and a prolonged progression-free survival. I’m hopeful that chemotherapy with osimertinib may be the future. But other targeted agents can also do the same thing, and we have to wait. But to me, the platform is still osimertinib plus something else. Which something else? We don’t know. Time will tell.

Transcript Edited for Clarity
View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: Working Group for Changing Standards in EGFR-Mutated Lung Cancers: Real-World Applications of the Evidence for NursesJun 29, 20191.5
Oncology Briefings™: Current Perspectives on Preventing and Managing Tumor Lysis SyndromeJun 30, 20191.0
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