First-line Osimertinib for EGFR-mutation Positive NSCLC

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The discovery of molecular biomarkers and EGFR mutations have shifted the management of NSCLC from traditional cytotoxic chemotherapies towards precision medicine with TKIs.
The discovery of molecular biomarkers and EGFR mutations have shifted the management of NSCLC from traditional cytotoxic chemotherapies towards precision medicine with TKIs.
The following article features coverage from the Chemotherapy Foundation Symposium (CFS) in New York, NY. Click here to read more of Cancer Therapy Advisor's conference coverage.

Osimertinib provides significant improvements in progression-free survival (PFS) over current standards of care among patients with EGFR mutation-positive non-small cell lung cancer (NSCLC) and should now be considered the standard of care, according to an oral presentation given by Edward S. Kim, MD, FACP, at the 35th Annual Chemotherapy Foundation Symposium in New York.1

The discovery of molecular biomarkers and EGFR mutations, such as exon 19 deletion and exon 21 L858R, have shifted the management of NSCLC from traditional cytotoxic chemotherapies towards precision medicine with the mutation-directed EGFR tyrosine kinase inhibitors (TKI).

A current challenge in the management of patients with NSCLC, however, is resistance to EGFR TKI via T790M mutation, which Dr Kim strongly suggested be confirmed by tissue or liquid biopsies. Osimertinib has been approved by the U.S. Food and Drug Administration for this indication.

The FLAURA study demonstrated that osimertinib improved PFS compared with erlotinib or gefitinib as frontline treatment in patients with EGFR mutation-positive NSCLC.

Patients treated with osimertinib had a PFS of 18.9 months compared with 10.2 months among patients treated with erlotinib or gefitinib. Response rates were similar in both study arms, but the osimertinib arm had nearly a 2-fold duration of response compared with the standard therapy (17.2 months vs. 8.5 months, respectively). Patients with central nervous system metastases had a median PFS of 15.2 months compared with 9.6 months for osimertinib and erlotinib or gefitinib, respectively. Overall survival data is not yet mature, but trended towards superiority for the osimertinib arm.

Dr Kim noted that osimertinib therapy is not infallible, adding that a new resistance mutation — C797S mutation — is the next challenge in the treatment of this patient population. He concluded that “[i]nitial therapy for frontline treatment in patients with NSCLC continues to evolve as biomarkers and newer agents enhance the personalized medicine approach.”

Read more of Cancer Therapy Advisor's coverage of the Chemotherapy Foundation Symposium (CFS) by visiting the conference page.

Reference

  1. Kim ES. Choosing a first-line EGFR TKI: what do the data tell us in 2017? Oral presentatiton at: 35th Annual Chemotherapy Foundation Symposium; November 8-10, 2017; New York, New York.

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