Learning Objectives Introduction

Introduction

This educational touchFEATURE explores how treatment of patients with epidermal growth factor receptor positive non-small cell lung cancer (EGFR+ NSCLC) can be optimized.

Recognizing the role of EGFR in NSCLC, the potential impact of EGFR tyrosine kinase inhibitors (TKIs) and therefore the importance of identifying patients with EGFR mutations, are key to optimizing the management of this population. As new therapies for EGFR+ NSCLC emerge, it is important to understand both the differences and similarities, as these can inform treatment choices. Treatment resistance is extremely common, so it is also important to identify the underlying mechanism – such as the presence of a T790M mutation or mutations in other pathways – as this can be a key factor influencing the choice of subsequent EGFR TKIs.1 The availability of first-, second- and third-generation TKIs and the possibility of using these agents across therapeutic lines,2 offer valuable options for patients with EGFR+ NSCLC. However, the sequencing of these therapies is a key clinical consideration when optimizing outcomes for these patients.

The information in this activity is intended for oncologists, nurses and other healthcare professionals involved in the treatment of patients with lung cancer.

This touchFEATURE is an ACCME-accredited activity.

Learning objectives

After accessing our interactive touchFEATURE, you should be able to:

1 AMA PRA Category 1 Credits™ Date of original release: 03 May, 2019 Date credits expire: 03 May, 2020

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touchFEATURE

How do we optimize first-line treatment selection and sequencing for patients with EGFR+ NSCLC in the era of third-generation tyrosine kinase inhibitors?

1 AMA PRA Category 1 Credits™ Date of original release: 03 May, 2019 Date credits expire: 03 May, 2020

Module 2: Patient journey: treat it right first time?

Professor Enriqueta Felip, Professor Frank Griesinger and Dr. Raffaele Califano present clinical cases addressing challenges in managing patients with EGFR+ advanced NSCLC.

Resistance mutations in patients with EGFR+ advanced NSCLC can emerge in response to treatment with EGFR TKIs and can influence the subsequent choice of therapy.10 The decision on how best to sequence EGFR TKIs in patients with EGFR+ NSCLC to maximize survival remains a key challenge.6,8,9 In addition, CNS metastases can develop and are challenging to treat. First- or second-generation EGFR TKIs show poor penetration into the CNS and patients may experience CNS relapse when treated with these agents.11 Early data support the ability of a third-generation EGFR TKI to cross the blood–brain barrier and penetrate the CNS, which may offer protection for the CNS, as well as treating metastases that are already present.6

Key Learnings

Please test your knowledge about the information presented. The following questions will need to be completed to progress.

Q1. In lung-adenocarcinoma, which of the following molecular alterations should be assessed at baseline?

a) EGFR
b) EGFR and HER2
c) EGFR, ALK, BRAF, ROS1
d) EGFR, ALK, BRAF, ROS1, PD-L1
e) PD-L1 only

The most recent treatment guidelines state that all patients with advanced adenocarcinoma should be tested for oncogenic drivers including EGFR, ALK, BRAF, ROS1 and PD-L1. Effective first-line therapies based on these biomarkers are widely available for patients with NSCLC and such treatments have shown improved benefit compared with chemotherapy.2

The most recent treatment guidelines state that all patients with advanced adenocarcinoma should be tested for oncogenic drivers including EGFR, ALK, BRAF, ROS1 and PD-L1. Effective first-line therapies based on these biomarkers are widely available for patients with NSCLC and such treatments have shown improved benefit compared with chemotherapy.2

The most recent treatment guidelines state that all patients with advanced adenocarcinoma should be tested for oncogenic drivers including EGFR, ALK, BRAF, ROS1 and PD-L1. Effective first-line therapies based on these biomarkers are widely available for patients with NSCLC and such treatments have shown improved benefit compared with chemotherapy.2

The most recent treatment guidelines state that all patients with advanced adenocarcinoma should be tested for oncogenic drivers including EGFR, ALK, BRAF, ROS1 and PD-L1. Effective first-line therapies based on these biomarkers are widely available for patients with NSCLC and such treatments have shown improved benefit compared with chemotherapy.2

The most recent treatment guidelines state that all patients with advanced adenocarcinoma should be tested for oncogenic drivers including EGFR, ALK, BRAF, ROS1 and PD-L1. Effective first-line therapies based on these biomarkers are widely available for patients with NSCLC and such treatments have shown improved benefit compared with chemotherapy.2

Next Question

You have successfully completed: Module 2: Patient journey: treat it right first time?

REFERENCES