Dr. Piotrowska on Treatment for EGFR-Mutant NSCLC

Zofia Piotrowska, MD, MHS, a medical oncologist at Massachusetts General Hospital and an instructor at Harvard Medical School, discusses treatment strategies for EGFR-mutant non—small cell lung cancer (NSCLC).

The randomized phase III FLAURA trial, which compared osimertinib (Tagrisso) with erlotinib (Tarceva) and gefitinib (Iressa), showed that osimertinib improved progression-free survival and overall survival compared with the first-generation EGFR drugs in patients with metastatic EGFR-mutant NSCLC. The FLAURA trial establishes osimertinib as a standard of care for newly diagnosed EGFR-mutant patients with NSCLC, according to Piotrowska.

Aside from monotherapy, some combination treatments have potential to become a standard of care, including the combination of EGFR inhibitors with VEGF-targeted therapies or with chemotherapy, says Piotrowska. Both of these strategies have shown promise when combined with first-generation EGFR inhibitors, according to Piotrowska, and upcoming trials will look at combinations with osimertinib.

Piotrowska says it is important to identify EGFR-mutant patients early because, even if they have high PD-L1 expression, EGFR inhibitors are the standard treatment. There is risk to starting immunotherapy prior to receiving the results of the EGFR test, because immunotherapy is not an effective treatment for patients with this molecular driver. Additionally, the risks of an EGFR inhibitor can be increased if started after immunotherapy. Therefore, the results of the EGFR test must be received before starting treatment to give EGFR-mutant patients the appropriate TKI, concludes Piotrowska.