Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 10Treatment of T790M mutation-negative disease after progression on an EGFR TKI
1:44 minutes.
TRANSCRIPTION:
DR LOVE: I was thinking about this when you were talking about your patient who had the T790M mutation in the pleural fluid, about what you would have done if the patient was T790M-negative. And I’d be curious about what you think are reasonable options in that situation and how you usually manage those patients. And how does the IMPRESS data relate to your decision? DR MOK: At this moment, I have to be pragmatic. Although it’s so-called our study, I will still give the patient chemotherapy alone. So even though the patient’s T790M-negative, considering our data, subgroup analysis, I still have to say that those data are not convincing enough to change practice. So I will only give chemotherapy. DR LOVE: So how about if I say, “So if you think about it, if they’re T790M-positive, hopefully they’re going to go on osimertinib.” If they’re T790M-negative, they’re going to go on chemotherapy. But one of the questions that has come up from a practical point of view — and I’m not sure you could really have teased that out with the IMPRESS study — is the possibility of disease flare when you pull somebody off an EGFR TKI, even though they are progressing. And I’ve heard people, Mark Kris is one who says, “What I do is, I keep the TKI going until I start to see them benefiting from the chemo.” DR MOK: That is always a debate. Personally, I don’t do that. I think the number of cases of real flare-up is actually not that high. And especially if I’m going to start the patient on chemotherapy, there’s a reasonable chance of disease control. So to my experience, that I actually — if I stop the TKI and put the patient on chemo, I hardly ever see any flare-up. DR LOVE: Interesting. |