Dr. Wakelee on Rationale to Explore Osimertinib With Concurrent Chemotherapy in EGFR-Mutant NSCLC

Heather A. Wakelee, MD, professor of medicine (oncology), Stanford University Medical Center, discusses the rationale to explore osimertinib (Tagrisso) in combination with concurrent chemotherapy in patient with EGFR-mutant non—small cell lung cancer (NSCLC).

Many patients with EGFR-mutant NSCLC will develop resistance to osimertinib. In approximately 5% to 10% of those cases, the EGFR TKI is still suppressing the cancer cells. If the TKI is stopped, it will lead to rapid growth of those cancer cells. These patients can easily be identified because they will become symptomatic within days of stopping the drug. For this subset, continuing the EGFR TKI along with the chemotherapy could be a potential strategy in practice.

Conversely, patients could have good control of their brain disease but begin to progress in the body. In practice, those patients are typically continued on osimertinib and given chemotherapy to control that progression. At the 2019 ASCO Annual Meeting, Wakelee presented a poster showing that the combination of osimertinib and chemotherapy is fairly safe. These data are not enough to warrant its use in routine practice, but it provides a foundation for further exploration, concludes Wakelee.