Dr. Mudad on RELAY Trial for EGFR-Mutant NSCLC

Raja Mudad, MD, FACP, a founding partner at Florida Precision Oncology, discusses the RELAY trial and using doublet therapy to treat EGFR-mutant non—small cell lung cancer (NSCLC).

The RELAY trial examined adding ramucirumab (Cyramza) to erlotinib (Tarceva) to see if the agents work better as a combination in patients with NSCLC who have an EGFR mutation. The progression-free survival (PFS) between single-agent erlotinib plus ramucirumab versus erlotinib plus placebo was 19.4 months versus 12.4 months, respectively, explains Mudad. Additionally, there was a significant elongation of PFS in single-agent erlotinib that is not as long as what would be seen with single-agent osimertinib (Tagrisso), according to Mudad.

Toxicity for the combination regimen had more toxicity related to VEGF inhibition, such as bleeding or thrombosis. Mudad believes the job of the physician is to find the ideal way of combining and sequencing [agents] to do better than single agents. One possibility is to start with a second- or first-generation EGFR inhibitor plus a VEGF inhibitor and follow that up with a third-generation EGFR inhibitor, says Mudad. Current trials are looking at osimertinib (Tagrisso) combined with ramucirumab or bevacizumab (Avastin), concludes Mudad.