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ASCO 2017: Options for NSCLC Patients Progressing After EGFR Treatment
Dr. Thomas Stinchcombe, Division of Medical Oncology, Duke University
At the 2017 ASCO annual meeting, Dr. Thomas Stinchcombe, Division of Medical Oncology, Duke University, described how ablative therapy and reinitiation of erlotinib can be used in EGFR-mutant non-small cell lung cancer (NSCLC) with CNS or limited systemic disease progression. Prospective data presented by Jared Weiss, University of North Carolina, showed that this is associated with a progression-free survival of 5-6 months. He commented, “This is a viable strategy as we try and extend the life of each line of our therapies“.
For T790M-positive NSCLC patients with disseminated disease or multiple progressing spots, osimertinib is the standard of care. This should be the preferred approach too in a subset of patients for whom no biopsy can be obtained or who are T790M-negative.
Dr. Stinchcombe reported a phase II trial evaluating T-DM1 in patients with HER2-positive metastatic NSCLC previously treated with chemotherapy. 34 % of the patients entered into two cohorts based on an immunohistochemical status (IHC) of 2+ or 3+ and received T-DM1. The response rate was 0% for patients testing IHC 2+ and 20% for those testing IHC 3+. “This is very good in pretreated patients. But additional research is needed to identify the patients mostly likely to benefit from T-DM1”, commented Dr. Stinchcombe. He correlated his study with the basket trial presented by Dr. Lee of the Memorial Sloan Kettering, but with patients selected on the basis of HER2 mutation. The response rate was about 44% - these are about 3% or 4% of adenocarcinomas. “That is very impressive“, concluded Thomas Stinchcombe. “I think that both these trials suggest that we should investigate this agent further in biomarker selected lung cancer patients”.