Adjuvant Treatment of EGFR+ NSCLC: Standard of Care

Roy S. Herbst, MD, PhD: The standard of care for EGFR-mutated non-small cell lung cancer after surgery right now is platinum therapy for those patients for whom it is indicated. In stage I, II, and III disease, platinum therapy is used. Most stage II patients, and a few with stage I, receive platinum therapy.

But after that, there's nothing else. And despite that, recurrence rates are high. Recurrence rates are as high as 50% at 5 years in stage I, 66% at 5 years in stage II, and as high as 75% at 5 years in stage III. All this is quite concerning and speaks of the unmet need and the need for new therapies.

Right now…if someone has EGFR-mutated disease, we would not use an EGFR inhibitor in the adjuvant setting. That's because previous studies were negative. The large RADIANT study looked at standard of care placebo at that time versus erlotinib, and it showed no improvement in disease-free survival of significance. The hazard ratio was [approximately] 0.6, which was not statistically significant. Until the ADAURA study, there has been no standard of care for how to treat EGFR+ disease with an EGFR inhibitor.

Transcript edited for clarity.