Kathryn A. Gold, MD
Data from the phase III FLAURA study cemented osimertinib’s (Tagrisso) place as the frontline standard of care for patients with EGFR
-mutation positive non–small cell lung cancer (NSCLC), said Kathryn A. Gold, MD.
-mutant NSCLC and the latest developments in SCLC.
OncLive: Please provide an overview of your presentation.
: As we all know, EGFR
-mutant lung cancer is important to recognize clinically because these patients are treated differently. They benefit from TKIs rather than from standard chemotherapy. Until very recently, our standard treatment for patients was erlotinib, afatinib (Gilotrif), or gefitinib in the frontline setting.
-mutant lung cancer. These patients were randomized to osimertinib versus the standard first-generation agents. The results were pretty impressive. Osimertinib clearly had improved PFS and [had] a trend toward improved overall survival [OS]. It’s also a very-well-tolerated drug. Our frontline standard of care has become osimertinib since those data were presented.
Is the future of osimertinib in combination or as a single agent?
Frontline osimertinib is here to stay for now. A 19-month PFS is pretty impressive for a very-well-tolerated drug. It’s tough to imagine frontline combinations coming in and beating [single-agent osimertinib], both in terms of tolerability and outcome.
The combinations will come in the treatment of resistance to osimertinib. We’re going to see more patients who are progressing on these drugs. Right now, we don’t have any [other] standard option for people who progress on osimertinib except for cytotoxic chemotherapy, which many of our patients would like to avoid if possible.
How has osimertinib’s approval affected sequencing for patients who progress?
It’s to be determined. Normally, if patients get erlotinib, afatinib, or gefitinib in the frontline setting and osimertinib at resistance, I don’t go back to the TKIs following progression. I tend to go straight toward chemotherapy. With osimertinib, we’re learning more about the resistance mechanisms.
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