EGFR-Mutant NSCLC Treatment Paradigm on Verge of Disruption

Silas Inman @silasinman
Published: Friday, Aug 18, 2017
Sarah B. Goldberg, MD

Sarah B. Goldberg, MD
Monotherapy with a tyrosine kinase inhibitor (TKI) is the frontline standard of care for patients with advanced EGFR-mutant non–small cell lung cancer (NSCLC), with 3 currently approved agents: erlotinib (Tarceva), gefitinib (Iressa), and afatinib (Gilotrif). Following acquired resistance, patients who test positive for the EGFR T790M mutation receive osimertinib (Tagrisso), while those with negative tumors undergo chemotherapy.

) July 27 to 29 in Huntington Beach, California. “I think we will have much more data in the next few months and maybe this will change our practice.”

Current Frontline Standards

The 3 currently approved frontline TKIs have similar efficacy but with varying toxicity profiles, with none showing superior overall survival (OS). The most recently added agent, afatinib, was compared with gefitinib in a head-to-head phase IIb study for patients with EGFR-mutant NSCLC.2

“Because of this trial, osimertinib is now the standard-of-care for patients. It has been approved for T790M-positive disease,” Goldberg said. “After progression, it has become standard to biopsy patients and, if T790M positive, to give osimertinib.”

Future Therapeutic Sequencing Considerations

Whether the frontline standard of care will be changed depends heavily on the magnitude of benefit seen with osimertinib. Although data from the phase III FLAURA study have not yet been released, Goldberg referenced phase I data from a 60-patient study of osimertinib in the first-line setting as a potential indicator.4
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Online CME Activities
TitleExpiration DateCME Credits
Advances in™ Therapies for Patients With ALK-Positive Lung Cancers: More Options…More Decisions…Better OutcomesAug 30, 20191.5
Oncology Briefings™: Treating Advanced NSCLC Without Actionable MutationsAug 30, 20191.0
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