Dr. Wakelee on First-Line Therapy for EGFR-Mutant Lung Cancer

Heather Wakelee, MD, professor of medicine, division of oncology, Stanford University, discusses first-line therapy for patients with EGFR-mutant lung cancer.

It is standard of care to test for EGFR mutations in patients who are newly diagnosed with advanced stage lung cancer, especially those with adenocarcinoma, says Wakelee. There are currently 3 FDA-approved drugs in the first-line setting, erlotinib (Tarceva), gefitinib (Iressa), and afatinib (Gilotrif), with a fourth—osimertinib (Tagrisso)—under consideration.

Osimertinib targets the T790M resistance mutation in EGFR-positive lung cancer, such as deletion 17 and L858R, says Wakelee, but debate on the use of it in this setting persists. This agent is currently approved to be given to patients after treatment with either erlotinib, gefitinib, or afatinib. In a head-to-head trial of osimertinib versus gefitinib or erlotinib, all 3 drugs elicited high response rates, but there was a difference in progression-free survival (PFS). Although PFS was longer with osimertinib, there was no clear overall survival benefit.