Dr. Low on Osimertinib Versus Dacomitinib in EGFR-Mutant NSCLC

Clarke A. Low, MD, director of thoracic oncology at Intermountain Healthcare, discusses the use of osimertinib (Tagrisso) versus dacomitinib (Vizimpro) as frontline therapy in patients with EGFR-mutant non—small cell lung cancer (NSCLC).

The phase III ARCHER 1050 trial evaluated the second-generation TKI dacomitinib versus the first-generation TKIs erlotinib (Tarceva) and gefitinib (Iressa) in patients with newly diagnosed EGFR-mutant NSCLC. Although dacomitinib demonstrated an improvement in overall survival versus gefitinib and erlotinib, dacomitinib required many of dose reductions. Moreover, patients with brain metastases were excluded from the study, as opposed to patients enrolled in the phase III FLAURA trial with osimertinib.

The toxicities of dacomitinib should not be prohibitive, says Low. However, given the need for dose reductions and the exclusion of patients with brain metastases in the ARCHER 1050 trial, Low advises the use of osimertinib as frontline therapy for the majority of patients with EGFR-mutant NSCLC.