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What is the First Line Treatment for EGFR-Mutant NSCLC?

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Published on August 5, 2020

First Line Treatments for EGFR Lung Cancer

How do lung cancer experts determine what treatment to use for an EGFR lung cancer patient's first line of treatment? In this segment from our recent Lung Cancer Answers Now program, two lung cancer experts, Dr. Bruce Johnson from Dana-Farber Cancer Institute and Dr. Alex Spira from Virginia Cancer Specialists discuss how they look at choosing one lung cancer drug over another when it comes to first line treatment for EGFR mutation NSCLC. Dr. Johnson says, "Use the most effective drug you have in your arsenal". Tune in to learn more.
This is Part 2 of a 4-part program. Watch Part 1 EGFR Lung Cancer Treatment News, Part 3 Managing EGFR Inhibitor Side Effects, and Part 4 Clinical Trials For EGFR Lung Cancer.


Transcript | What is the First Line Treatment for EGFR-Mutant NSCLC?

Jill Feldman:

There's a lot of talk within the community about this sequential treatment, right? And so wondering, "Well, if I go on a erlotinib (Tarceva) or afatinib (Gilotrif) first, I could save osimertinib (Tagrisso) for next." Can both of you touch on that and what the thought process is when it comes to first line of treatment?

Dr. Spira:

So I think if you look at the studies that really drove osimertinib to be first line therapy published a few years ago, the head to head comparison showed that osimertinib was better than the other drugs. And I think that allows for a couple of things. One would assume that if you had got some of the earlier drugs, such as erlotinib or afatinib, many of those patients may have gotten or should have gotten osimertinib at that point. So I think that in and of itself tells us that it's a better drug, because those studies really were looking at the most important thing, which is overall survival. So, it gets down to the old analogy, do you want to play your best cards first, or do you want to have a lot of cards? And I think we've seen not only in the EGFR world, but in other worlds as well, ALK inhibitors as well, that it's probably best to play your best card first. There's also scientific rationale. We know that osimertinib gets into the brain better as well.

So we think there's multiple different reasons that it's probably better to start with that drug first, rather than using them sequentially based upon what we're seeing.

Dr. Johnson:

Yeah. I agree with Dr. Spira. Our approach in oncology is that use your best drug first. Use the most effective drug you have in the arsenal. And one of the other things that's been great is that, and one of the things that you've lived through is that, the research takes place at a pace that they come up with new solutions for the problems that emerge with even the best drug. So, one of the things we know now is that some of the resistance mechanisms to osimertinib will allow them to still be sensitive to using some of the first generation inhibitors, gefitinib and erlotinib and we have a current clinical trial where we put together, gefitinib and osimertinib at the same time to see if you can delay the progression, because the combination can be given safely number one. And then number two is that we want to wait and see if this can prevent it same as osimertinib worked for the most common resistance mechanism, which is how it was initially approved. And it works better in the first line as well.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.


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