Dr. Ramalingam on Treatment After Osimertinib in EGFR-Mutant NSCLC

Suresh S. Ramalingam, MD, FASCO, deputy director, director, Lung Cancer Program, Winship Cancer Institute of Emory University, professor, assistant dean, Roberto C. Goizueta Distinguished Chair for Cancer Research, director, Division of Medical Oncology, Department of Hematology and Medical Oncology, Emory University School of Medicine, discusses treatment after osimertinib (Tagrisso) in EGFR-mutant non–small cell lung cancer (NSCLC).

The current standard of care for patients with advanced EGFR-mutant NSCLC is chemotherapy, says Ramalingam. Previously, findings from an exploratory analysis of the phase 3 IMpower150 trial suggested that atezolizumab (Tecentriq) plus chemotherapy and bevacizumab (Avastin) could provide clinical benefit to patients with EGFR mutations who failed on treatment with TKIs. However, data from a single-center, retrospective study presented during the 2021 European Lung Cancer Virtual Congress demonstrated that treatment with chemotherapy plus immunotherapy did not demonstrate significant clinical benefit vs chemotherapy alone in patients with EGFR-mutated NSCLC after progression on osimertinib.

Results showed that the median overall survival (OS) for patients who received chemotherapy plus immunotherapy (n = 12) was 10.9 months (95% CI, 9.4–not estimable [NE]) vs 10.6 months (95% CI, 6.9-19.5) with chemotherapy alone (n = 29). In patients who were treated with chemotherapy plus bevacizumab (n = 34), the median OS was 13.9 months (95% CI, 10.2–NE).

These results confirm the activity of chemotherapy in patients who progress on osimertinib, says Ramalingam. However, whether the addition of bevacizumab and immunotherapy provide additional benefit should be verified in a prospective trial. To that end, the phase 3 KEYNOTE-789 trial is evaluating pembrolizumab (Keytruda) plus pemetrexed (Alimta) and platinum chemotherapy in patients with TKI-resistant EGFR-mutant NSCLC.