Dr. Wakelee on Advances in EGFR-Mutant NSCLC Treatment

Heather A. Wakelee, MD, professor of medicine (oncology), Stanford University Medical Center, discusses osimertinib (Tagrisso) and its role in treating patients with EGFR-mutant non—small cell lung cancer (NSCLC).

Osimertinib is the only FDA-approved third-generation EGFR TKI. Initially, it was indicated for patients who had already been treated with a first- or second-generation drug and had the acquired resistance mutation T790M. In this setting, osimertinib elicited a 60% to 70% response rate and responses can last ≥1 year in select patients, according to Wakelee.

The FLAURA study examined osimertinib in the first-line setting. In the trial, patients with EGFR mutation-positive NSCLC received either osimertinib or standard EGFR TKI, which was gefitinib (Iressa) or erlotinib (Tarceva). Results showed that the median progression-free survival of 19 months. Osimertinib has become the standard first-line therapy in the United States for this patient population, according to Wakelee. It is a well-tolerated agent, but physicians must be mindful of its unique toxicities, including neutropenia, thrombocytopenia, and QT prolongation, Wakelee explains, adding that she recommends physicians check lab reports and electrocardiogram, especially early on.

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