Dr. Garon on Potential for Immunotherapy in EGFR+ NSCLC

Edward B. Garon, MD, director of Thoracic Oncology at the Jonsson Comprehensive Cancer Center at University of California, Los Angeles, discusses the potential for immunotherapy in the treatment of patients with EGFR-positive non—small cell lung cancer (NSCLC).

In the IMpower150 study, patients with NSCLC derived benefit from the frontline combination of atezolizumab (Tecentriq), bevacizumab (Avastin), carboplatin, and paclitaxel. Based on the positive data, the FDA approved the regimen in December 2018 for frontline use in patients with metastatic nonsquamous NSCLC, excluding patients with EGFR/ALK aberrations. In this large, multicenter study, about 100 patients had EGFR mutations, demonstrating potentially encouraging data in that subset, Garon says.

Based on the current data, however, it seems that the role of immunotherapy would fall in the later lines of treatment after a patient has progressed on an EGFR TKI, preferably osimertinib (Tagrisso). In fact, data evaluating the use of checkpoint inhibitors before the use of a targeted agent in this population are scant, Garon notes.

He is hopeful that the current data with immunotherapy in EGFR-positive disease is not the best that can be seen with this approach, because as it stands, the regimen is rather toxic. Although the study showed a survival advantage with the addition of immunotherapy, researchers still hope for better efficacy data in the coming years.

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