Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 3Afatinib/cetuximab for patients with T790M mutation-negative NSCLC
1:49 minutes.
TRANSCRIPTION:
DR LOVE: Initially, people were excited about cetuximab/afatinib. Then it seemed like when they started to see the stuff coming out on the next-generation TKIs, kind of forgot that. And now I’m hearing people talk more about that. What about afatinib/cetuximab in the patient with T790M-negative disease? DR MOK: I still use it from time to time. I mean, it’s based on the single-arm Phase II study on 100 patients. They got a response, about 30%. The concept itself is actually what I call a so-called pan-EGFR/ALK inhibition, both the monoclonal antibody on the surface and, also, in the intracellular kinase. To me, that is just a very potent EGFR inhibition. It does not inhibit specifically T790M, but certainly some patients do benefit from it. I can tell you from some personal experience from another case who was exon 19-positive, did well on gefitinib for almost like 2 years, progressed. I put him on afatinib plus cetuximab, and he was good for another year. And eventually he progressed, and then he turned out to be T790M-positive. DR LOVE: Wow! DR MOK: And now he’s on osimertinib. DR LOVE: Wow! When I first heard about cetuximab and afatinib, I thought, “Oh. That does not sound good for the skin.” And yet I hear from investigators that somehow it’s not that bad, because, quote, they’ve already had their skin sensitized from having a TKI? Or is it really a problem? DR MOK: Yes and no. I mean, I have seen some pretty bad skin toxicity. But to me, it’s the dose. You actually use 500 mg/m2 every 2 weeks. I think that’s too much. And you don’t need that much to inhibit your EGFR. So I actually use 250, which is actually a more tolerable dose. |