Dr. Bertino on Frontline Dacomitinib in Metastatic EGFR+ NSCLC

Erin M. Bertino, MD, a medical oncologist at The Ohio State University Comprehensive Cancer Center—James, discusses the use of dacomitinib (Vizimpro) in the treatment of patients with non–small cell lung cancer (NSCLC) with EGFR mutations and its place among other available EGFR TKIs.

In September 2018, the FDA approved dacomitinib for use in the frontline treatment of patients with metastatic NSCLC with EGFR exon 19 deletion or exon 21 L858R substitution mutations. The regulatory decision was based on data from the phase III ARCHER 1050 trial, in which dacomitinib was compared head-to-head with gefitinib (Iressa). Results from the trial showed that dacomitinib led to improved progression-free survival over gefitinib, says Bertino. Now, 5 FDA-approved EGFR inhibitors are available in this space. However, it is unclear how dacomitinib will fit into the treatment landscape, adds Bertino.

In the United States, there will likely be continued use of osimertinib (Tagrisso) because of its favorable toxicity profile and positive data, according to Bertino. Finding a place for dacomitinib is going to be challenging, adds Bertino; this agent is likely to fall into the same category as erlotinib (Tarceva), gefitinib, and afatinib (Gilotrif), which all play second fiddle to osimertinib, Bertino concludes.