D. Ross Camidge, MD, PhD, director of thoracic oncology, University of Colorado, discusses optimal treatment regimens for patients with EGFR-positive non–small cell lung cancer (NSCLC).
In the treatment of this oncogene-driven subset, it seems that the standard initial therapy is with the third-generation tyrosine kinase inhibitor osimertinib (Tagrisso). This agent was granted a second FDA indication in April 2018 for the frontline treatment of patients whose tumors harbor EGFR mutations (exon 19 deletions or exon 21 L858R substitution mutations). In terms of progression-free survival, sequential therapy might work just as well, but Camidge argues that a patient would likely rather take 1 oral drug.
This opens the doors to the next steps in research. Ongoing trials are looking at osimertinib in combination with antiangiogenic agents like bevacizumab (Avastin) or with chemotherapy. However, Camidge says the more pressing question is why patients become resistant to osimertinib, and then developing rational combinations to overcome this.