Which way now for TKIs in EGFR mutation-positive lung cancer?

EGFR tyrosine kinase inhibitors (TKIs) are established first-line treatments for EGFR mutation-positive non-small-cell lung cancer (NSCLC) but their optimum use continues to be explored

Yesterday’s Proffered Paper session featured results from first-line studies with the potential to influence the application of these agents in practice. In the overall survival analysis of the phase IIb LUX-Lung 7 trial (with a median follow-up of 42.6 months), afatinib improved survival compared with gefitinib (median 27.9 months versus 24.5 months), although the difference was not significant (hazard ratio 0.86; p=0.258) (Abstract 440O).

The effect, said Li Zhang (Sun-Yat-sen University Cancer Center, Guangzhou, China), was consistent across del19 and L858R mutation subtypes. In line with the primary analysis,1 updated progression-free survival, time-to-treatment failure and overall response analyses significantly favoured afatinib and the adverse event (AE) profiles were unchanged. Combining erlotinib with the anti-PD-L1 antibody atezolizumab, in an effort to prolong TKI response, was associated with manageable safety in a phase Ib study of 28 patients, according to Brigette Ma (The Chinese University of Hong Kong, Shatin, China) (Abstract 441O).

Altogether, 39% of patients had treatment-related grade 3–4 AEs and five receiving atezolizumab discontinued due to AEs. There was no pneumonitis. Efficacy was promising, with response and disease control rates of 75% and 90%, respectively, among 20 patients with EGFR mutation-positive NSCLC.

1. Park K, et al. Lancet Oncol 2016;17:577–89

This article appeared in the Sunday 18 December 2016 edition of the  Congress Highlights.