Available Options for the Treatment of EGFR+ Lung Cancer

Edward B. Garon, MD, MS, professor of medicine, Geffen School of Medicine, Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, provides an overview of some of the available treatment options for patients with EGFR-mutated lung cancer as well as the options for patients who develop resistance to EGFR tyrosine kinase inhibitors (TKIs).

TRANSCRIPTION:

0:10 | There are multiple approved approaches right now in the frontline, as well as [in] previously treated patients, and some new emerging therapies. In the frontline setting, FDA-approved regimens include first-generation EGFR inhibitors, which are really erlotinib [Tarceva] and gefitinib and are effective. Also, second-generation agents, afatinib [Gilotrif] and dacomitinib [Vizimpro], are approved. Afatanib, of note, is also approved for 3 uncommon mutations where it is the sole approval.

0:49 | The most commonly used agent is single-agent osimertinib [Tagrisso]. There also is an FDA approval for erlotinib and ramucirumab [Cyramza], an anti-angiogenic, as well as the potential for looking at erlotinib and bevacizumab [Avastin] based on NCCN guidance, and also gefitinib plus chemotherapy. Those would be the current frontline approaches that people are able to incorporate.

1:18 | For the rare patients who still have gotten a first-generation or second-generation agent as their initial therapy, and have not received osimertinib, osimertinib is approved at the time progression. Lazertinib [YH25448] also has an approval and patients who have developed resistance with the T790M mutation. For the remainder of patients, the established approach would be platinum-based chemotherapy.

1:53 | In a period in which we get next-generation sequencing in many of our patients, oftentimes, we will find additional mutations that are associated with potential response to dual TKI therapy. The reality though, is although that is something that is often done in an academic practice, we don't really have good data on these approaches. I think that it is a lot to expect that people in the community would be trying to mix and match drugs that aren't approved in settings where our biomarkers are not entirely clear.