Published on August 4, 2020
Non Small Cell Lung Cancer EGFR Mutation Treatment
Transcript | EGFR Lung Cancer Treatment News
Hello, I'm Andrea Hutton and welcome to our Lung Cancer Answers Now program. Today we're talking about treatment news for lung cancer patients, specifically with the EGFR mutation.
First, I'd like to introduce our panel, Dr. Johnson. Dr. Bruce Johnson is the Chief Clinical Research Officer at Dana-Farber Cancer Institute. And Dr. Alex Spira, who's the Director of the Phase I Trial Program at Virginia Cancer Specialists Research Institute. We also have joining us today, two amazing patient advocates, Jill Feldman and Mike Smith, and they'll be helping bring the patient voice into our conversation. So thank you everyone for joining us today.
Two subjects came up in the questions that were sent in to us in advance over and over again. So the first bucket really revolves around, what is new? What's the latest treatment information that is out there? So, Dr. Johnson, I'd love to start with you. What's new? Tell us what's on the forefront.
Well, thank you, Andrea. I want to mention a few things that I think have come to our attention within the past few months. One of the most dramatic things that we've seen for the people with EGFR mutations is the recent adjuvant study that was reported at the plenary session of the American Society of Clinical Oncology. The plenary session is picked from all different types of cancers and it is determined to be the big practice changing events. And there was a study that was performed, it's called ADAURA. And the study design was to take people with early stage resected lung cancers and randomize them to either the new EGFR tyrosine kinase inhibitor, osimertinib (Tagrisso), or observation after they receive all the conventional treatment after their surgery. And it reduced the risk of the lung cancer coming back by about 80%. And it's one of the most dramatic examples of a difference in the trial end points that we've seen in randomized studies.
And this is in contrast to a reduction of five or 10% or somewhere between five and 20% that you see when you give conventional chemotherapy treatment. So this is pretty impressive. The part that I said, that the end point that they looked at here was the chance of the cancer coming back. But there will be additional follow-up to find out if it's going to make a difference in their survival. But this is a very dramatic example. To compare this, when they use the existing tyrosine kinase inhibitor and it's a smaller subgroup using erlotinib (Tarceva), one of the older tyrosine kinase inhibitors, you saw a reduction of it, chance of the cancer coming back by about 40% in a Genentech trial. So this doubled it. So it's quite a difference.
The second study that I thought was pretty important was a study that came out of China reported by Dr. Wang. And here they had people with EGFR mutations and if they isolated the tumors to five or fewer spots and gave radiation, you could extend how long the epidermal growth factor receptor tyrosine kinase inhibitor would work. So this is something we'd seen before in other types of lung cancer that did not have the EGFR mutation. And so, this, we think, will be important for people that comes back and just one spot, or they just have a couple of spots, the EGFR tyrosine kinase inhibitor is working well.
The other ones I won't go into as much detail. The one other thing that I think that is new is there's a study that's starting and one of the things that people have been looking for, for a long time is, can you add anything to the epidermal growth factor receptor tyrosine kinase inhibitors? And there's been a number of different types of drug - MEK inhibitors, and also MET inhibitors. One of the ones that we think will be an important study that's just launching now is, comparing giving osimertinib to osimertinib plus chemotherapy. So that trial is just beginning enrollment and we are going to be opening it up at our center and be offering this to find out if the chemotherapy plus the epidermal growth factor receptor, tyrosine kinase inhibitor will work longer.
Yes, actually you brought up a good point, Dr. Johnson with the ADAURA study and how exciting that is. I don't even think way back when they had the breast cancer studies with like tamoxifen (Soltamox), they had that good of a margin. But I think one thing that is really confusing about that study for people is, the difference between progression free and disease free. So can you just explain that for a moment?
So, the term progression free means that in all these studies, we have people come back at regular intervals, and it's typically between every two to four months. And we typically do images, usually a CT scan, taking a look at people's lungs and liver and adrenal, and the time when the progression free survival ends, that end point that they use in clinical trials is when the cancer shows up somewhere. So it's much different than survival. Now, one of the reasons why progression free survival is important is that you get the information sooner. And especially with people with EGFR mutations, there's a lot of different types of treatments and you need to wait a long time to find, and we think it's a good problem, you have to wait a long time to find out what a person's survival is. it's typically years.
And one of the things in cancer therapy, particularly in the adjuvant therapy is you take a look at progression free survival and one of the reasons why it's acknowledged is that it's typically a surrogate marker, meaning it's an early readout of the efficacy of the treatment and you get the information, in this case years before you'll get the information on survival. And one of the quandaries is, what do you do with this information when you have such a dramatic prolongation and progression free survival, but it's going to be years until you get the information about survival? And one of the things that all of us deal with, with our patients is, what do you do until that information becomes available? And you have to make the decisions with what you have.
I think a lot of the concern with this is because traditionally with these adjuvant studies, and that's what this was, an adjuvant study, is you really look at overall survival as the end point. But the PFS, progression free survival was so profound as Dr. Johnson said, I mean, 80% risk of reduction in anything is a huge number. So number one is, we all believe that's going to translate probably not as high a number, but it's an overall survival end point, which is what everybody wants to hear. And then secondarily, even if it's just progression free survival, that is a meaningful endpoint to a lot of people.
It's always easy to criticize a study of such good numbers, but this really is going to be a deal changer, even if the numbers don't hold up as well. And even if a lot of those people still come back over time. So, I think for most of us, especially in the United States, this is going to be practice changing.
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