Highlights from Gather Session: EGFR-positive Metastatic Non-Small Cell Lung Cancer
NSCLC Connect recently hosted a Q&A session with Oncologists regarding EGFR-positive Metastatic Non-Small Cell Lung Cancer (mNSCLC)
Below are some highlights from the discussion:
Some respondents noted that clinical trial data (such as from the recent RELAY study) showed the combined use of ramucirumab plus erlotinib was useful in some patient populations; however, various oncologists said they wouldn’t change from their current choice of treatment due to factors of cost and convenience.
- “The data that came from the RELAY study, which was a Phase 3 study using this combination ramucirumab plus erlotinib versus erlotinib plus placebo, was very, very good and were described in the RELAY study. This study basically showed impressive progression-free survival and basically matched the exon 19 deletion, which is the most sensitive EGFR mutation that we have identified so far.”
- “The data is very impressive in patients with EGFR mutation due to dual blockage. In patients who have EGFR mutation, I definitely would treat them combining VEGF inhibitor for improvement in progression-free survival. It is not going to be used in all patients but subgroup of patients who have good performance status and EGFR mutated would be the patient I will use.”
- “Clinical data is very important as a basis of how I make my decisions when I decide to pick a combination to treat and having a PFS in first line similar to osimertinib for this combination at 19 months, PFS is impressive. I've been still picking single-agent osimertinib over this combination just for more convenience for patients.”
- “I realize that the data is competitive in terms of prognostic outcomes, progression-free survival, and maybe even overall survival, but the cost of using Tagrisso is less than the cost of using combination of ramucirumab with erlotinib, which is a far more expensive program of treatment.”
Regarding their thoughts on the treatment options currently available for patients with EGFR mutations – specifically EGFR exon 21, several respondents expressed other preferences, but were open to trying erlotinib and ramucirumab based on emerging data.
One respondent noted the need for second- or third-line options for their mNSCLC patients.
- “I think patients have excellent available treatment options for first line, be it osimertinib or combination of erlotinib with ramucirumab. I think the biggest unmet need for those patients after they progress on first line, what to do next, so we tend to move to chemotherapy or chemotherapy and immune therapy, but it goes quickly downhill. We don't have good second- or third-line targeted options like we do have in ALK-positive lung cancer, and I wish we had more targeted therapy in that setting, especially newer-generation TKIs.”
For discussions with patients regarding choice of treatment, most respondents offered support, with conversation often focusing on quality of life, survival, etc.
- “I explain to them this is palliative and the goal is to keep their disease in check as much as possible to minimize side effects or complications of the disease. We discuss quality of life. We tell them that we could start therapy and watch for side effects. And if they're not tolerating, or if we can get their side effects under control, we would recommend transitioning to best supportive care or hospice.”