Heather A. Wakelee, MD
Novel treatments and strategies continue to emerge in the treatment paradigm for patients with EGFR
–positive non–small cell lung cancer (NSCLC), explained Heather Wakelee, MD.
OncLive: Can you highlight some of the latest advances in EGFR-positive lung cancer?
: There is a lot happening in the EGFR space. We now have several first-generation drugs and a couple of second-generation drugs. Third-generation osimertinib has also been FDA approved. Most of the recent data that have been very interesting are the direct comparisons. Until very recently, we went for many, many years without having direct comparisons of different TKIs in the first-line setting.
mutations—we did trials of EGFR TKIs plus chemotherapy, which were negative. That left everyone with the idea that we shouldn't do that. It took a long time before those questions were asked again. Japanese researchers did a great study looking at first-line chemotherapy plus an EGFR TKI. The OS was in excess of 15 months. This was statistically significant, and it goes away from what we thought to be the truth.
Will there ever be a head-to-head comparison with osimertinib and dacomitinib?
There might be, but it's not likely. This is just because dacomitinib is unlikely to beat osimertinib for that PFS endpoint. It certainly won't win from a toxicity standpoint. I can't imagine they would do this trial. The better trial would be starting with osimertinib, and then after progression going over to dacomitinib. We could work chemotherapy into the mix, as well, and see how this impacts PFS and OS. This kind of study would probably be hard to accrue to, at least in the United States. There is the potential for a global study.
- Ramalingam S, Reungwetwattana T, Chewaskulyong B, et all. Osimertinib in untreated EGFR-mutated advanced non–small-cell lung cancer. N Engl J Med. 2018; 378:113-125. doi: 10.1056/NEJMoa1713137.
- Mok T, Cheng Y, Zhou X, et al. Dacomitinib versus gefitinib for the first-line treatment of advanced EGFR mutation positive non-small cell lung cancer (ARCHER 1050): a randomized, open-label phase 3 trial. J Clin Oncol. 2017;35(suppl; abstr LBA9007).
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