Dr. Pacheco on Frontline Therapy for Patients With EGFR-Mutant NSCLC

Jose M. Pacheco, MD, an assistant professor of medicine/medical oncology at the Colorado University School of Medicine, discusses frontline therapy for patients with EGFR-mutant non—small cell lung cancer (NSCLC).

The established genetic alterations for which physicians have approved targeted therapies include EGFR activating mutations, ALK fusions, ROS1 fusions, and BRAF V600E mutations, says Pacheco. Data from the FLAURA study presented within the past year suggested that first-line osimertinib (Tagrisso) provides a progression-free survival (PFS) benefit for patients with traditional EGFR activating mutations, such as exon 19 deletions and EGFR L858R point mutations in exon 21. The PFS benefit for osimertinib compared with gefitinib (Iressa) or erlotinib (Tarceva) was 19 months versus 10 months, notes Pacheco.

From a population-based standpoint, it makes more sense to give osimertinib first as opposed to sequencing EGFR inhibitors. If 100 patients are treated with osimertinib, the median PFS could be 19 months based on the trial data. If 100 patients are treated with gefitinib or erlotinib, the median PFS would be approximately 10 months, and only 50% to 60% of those patients would be eligible for sequencing with osimertinib. As high as 40% of patients may not reach second-line therapy, so it is important to give patients the therapy with the most impact upfront, adds Pacheco.