Heather Wakelee, MD, associate professor of Medicine (Oncology) at Stanford University Medical Center, discusses available treatment for patients with lung cancer who progress without a T790M mutation.
Heather Wakelee, MD, associate professor of medicine (oncology) at Stanford University Medical Center, discusses available treatment for patients with lung cancer who progress without a T790M mutation.
If T790M is not found, patients can be put on a clinical trial. There are some with combinations of EGFR tyrosine kinase inhibitors (TKIs) to increase responses, even if a patient doesn't harbor the T790M mutation. There is also chemotherapy as an option, says Wakelee. Most EGFR-mutant lung cancers are very sensitive to chemotherapy, making it important to talk with patients so they are prepared for it.
If a patient starts on a first- or second-generation EGFR inhibitor, the next line would be osimertinib (Tagrisso) or one of the other drugs that are being developed, such as another EGFR TKI or chemotherapy. If osimertinib is given in the first-line setting, physicians are starting to understand what this resistance looks like. If a patient develops a C797S resistance mutation without T790M, then perhaps some of the first- and second-generation drugs could work, whereas if a patient has both, that is not the case, explains Wakelee.