Elaine Shum, MD
Following frontline TKI approvals, researchers are still trying to determine the role of older-generation TKIs in the treatment of patients with oncogene-driven non–small cell lung cancer (NSCLC), as well as ways to overcome acquired resistance to these agents, said Elaine Shum, MD.
Osimertinib (Tagrisso), a third-generation EGFR TKI, gained FDA approval in the frontline setting in April 2018 for patients with NSCLC whose tumors harbor EGFR
mutations (exon 19 deletions or exon 21 L858R substitution mutations). The decision was based on data from the phase III FLAURA study, in which frontline osimertinib reduced the risk of progression or death by 54% versus first-generation TKIs erlotinib (Tarceva) or gefitinib (Iressa). The median progression-free survival (PFS) was 10.2 months (95% CI, 9.6-11.1) for standard therapy and 18.9 months (95% CI, 15.2-21.4) with osimertinib (HR, 0.46; 95% CI, 0.37-0.57; P
<.0001). Overall survival (OS) data have not yet been published.
-positive NSCLC treatment, alectinib (Alecensa) has been identified as standard frontline therapy following its November 2017 FDA approval. In November 2018, lorlatinib (Lorbrena) became the most recent ALK inhibitor to be approved for second-line treatment following progression on 1 or more ALK TKIs.
In an interview during the 2018 OncLive®
State of the Science Summit™ on Advanced Non–Small Cell Lung Cancer, Shum, a medical oncologist at NYU Langone’s Perlmutter Cancer Center, discussed the rapidly evolving treatment options for patients with oncogene-driven NSCLC.
OncLive: What are the updates in frontline options for patients with oncogene-driven NSCLC?
: It has been a very exciting past couple of years in terms of new FDA approvals for drugs in the frontline setting. In my presentation [at the State of the Science SummitTM], I focused on ALK- and EGFR-[targeted therapies], and I also touched on some of the rarer oncogenic drivers.