Dr. Ross on the Utility of First- and Second-Generation EGFR Inhibitors in EGFR-Mutant NSCLC

Helen J. Ross, MD, medical oncologist, Banner MD Anderson Cancer Center, discusses the utility of first- and second-generation EGFR inhibitors in EGFR-mutant non–small cell lung cancer (NSCLC). 

Since the 2018 FDA approval of osimertinib (Tagrisso) for the frontline treatment of patients with EGFR-mutant metastatic NSCLC, the use of first- and second-generation EGFR inhibitors has declined, says Ross. However, certain circumstances may warrant using a first- or second-generation agent vs osimertinib. For example, some patients with EGFR-mutant NSCLC who develop resistance to osimertinib may still be sensitive to a first- or second-generation inhibitor, says Ross. Research efforts are ongoing to understand which patients may require this treatment approach, Ross adds.

In general, patients in the United States will receive osimertinib in the frontline setting, explains Ross. Moreover, based on the survival advantage noted with osimertinib vs gefitinib (Iressa) or erlotinib (Tarceva) in the phase 3 FLAURA trial (NCT02296125), it is likely that osimertinib is the optimal treatment approach for this patient population, Ross says. Additionally, utilizing osimertinib as a first-line therapy is warranted because approximately 20% to 30% of patients with NSCLC will not receive second-line therapy. Ultimately, it is important to utilize the most effective agent up front, Ross explains.

Notably, patients who were receiving a first- or second-generation EGFR inhibitor prior to the approval of osimertinib should remain on therapy if they are tolerating it and have disease control, Ross concludes.