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 3: Panel discussion – Third-generation EGFR TKIs: how can we use them now and in the future?

Professors Solange Peters, Enriqueta Felip and David Planchard discuss the role of third-generation EGFR TKIs in the first-line treatment of EGFR+ NSCLC and the implications of this choice on subsequent treatment outcomes.

The third-generation EGFR TKI has been found to be effective in patients with the commonly acquired T790M mutation and has demonstrated significant increases in progression-free survival over standard-of-care treatment as both first- and second-line therapy.8,9 This raises key questions on how best to use third-generation EGFR TKIs and how to optimize outcomes for patients with EGFR+ advanced NSCLC. The European Society of Medical Oncology (ESMO) clinical practice guidelines2 have recently been updated to incorporate the use of the third-generation EGFR TKI in the first-line setting, although it is not clear how this will impact clinical practice and treatment sequencing. This therapeutic landscape continues to evolve rapidly – what does the future hold for EGFR+ NSCLC treatment?

Key Learnings

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

Q1. In the FLAURA trial, which compared first-line therapy using osimertinib with standard of care, median progression-free survival for patients receiving osimertinib was:

a) 4.4 months
b) 10.1 months
c) 15.6 months
d) 18.9 months

FLAURA was a double-blind phase 3 trial that included patients with EGFR+ NSCLC who were EGFR TKI-naive. The median progression-free survival with osimertinib was 18.9 months (95% CI, 15.2–21.4), compared with 10.2 (95% CI, 9.6–11.1) with standard EGFR TKI treatment. The median duration of response was 17.2 months (95% CI, 13.8–22.0) with osimertinib and 8.5 months (95% CI, 7.3–9.8) with standard EGFR TKI treatment. Adverse events of grade 3 or higher were reported in fewer patients who received osimertinib than standard EGFR TKI treatment.8

FLAURA was a double-blind phase 3 trial that included patients with EGFR+ NSCLC who were EGFR TKI-naive. The median progression-free survival with osimertinib was 18.9 months (95% CI, 15.2–21.4), compared with 10.2 (95% CI, 9.6–11.1) with standard EGFR TKI treatment. The median duration of response was 17.2 months (95% CI, 13.8–22.0) with osimertinib and 8.5 months (95% CI, 7.3–9.8) with standard EGFR TKI treatment. Adverse events of grade 3 or higher were reported in fewer patients who received osimertinib than standard EGFR TKI treatment.8

FLAURA was a double-blind phase 3 trial that included patients with EGFR+ NSCLC who were EGFR TKI-naive. The median progression-free survival with osimertinib was 18.9 months (95% CI, 15.2–21.4), compared with 10.2 (95% CI, 9.6–11.1) with standard EGFR TKI treatment. The median duration of response was 17.2 months (95% CI, 13.8–22.0) with osimertinib and 8.5 months (95% CI, 7.3–9.8) with standard EGFR TKI treatment. Adverse events of grade 3 or higher were reported in fewer patients who received osimertinib than standard EGFR TKI treatment.8

FLAURA was a double-blind phase 3 trial that included patients with EGFR+ NSCLC who were EGFR TKI-naive. The median progression-free survival with osimertinib was 18.9 months (95% CI, 15.2–21.4), compared with 10.2 (95% CI, 9.6–11.1) with standard EGFR TKI treatment. The median duration of response was 17.2 months (95% CI, 13.8–22.0) with osimertinib and 8.5 months (95% CI, 7.3–9.8) with standard EGFR TKI treatment. Adverse events of grade 3 or higher were reported in fewer patients who received osimertinib than standard EGFR TKI treatment.8

Next Question

You have successfully completed: Module 3: Panel discussion – Third-generation EGFR TKIs: how can we use them now and in the future?

REFERENCES