Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 6Case discussion: A 70-year-old man with EGFR mutation-positive metastatic NSCLC experiences disease progression on an EGFR TKI and is determined to have T790M mutation-positive disease
2:41 minutes.
TRANSCRIPTION:
DR LOVE: You had this patient you brought in today, this 70-year-old man who kind of, again, went through a typical thing, got erlotinib. Looks like here you found the T790M in the serum and on repeat biopsy, if I’m reading this right, and is now on osimertinib. First, is that correct up to this point? DR BLUMENSCHEIN: Exactly. So I sent off the serum, but again, because the serum’s not 100%, and if it’s negative, I still want tissue. We went ahead and got a biopsy as well. And the serum came back positive several weeks later. And so we brought him back in to initiate treatment. And then he had confirmatory findings on his biopsy. DR LOVE: Where was the biopsy done? DR BLUMENSCHEIN: He had a biopsy of his liver. DR LOVE: And I’m curious about what happened to the tumor. DR BLUMENSCHEIN: He’s actually responded. He’s doing quite well. He’s had a good robust response, as he did initially with his first-generation EGFR TKI. And he’s doing well with this now. DR LOVE: The thing that interested me, because I’m still trying to kind of figure this out, is you say he’s had problems with a skin rash. And what happened there? DR BLUMENSCHEIN: His skin rash, he’s had some waxing and waning rash. And these third-generation drugs don’t have the same degree of rash, generation of rash as you do see with the first-generation drugs. And he had a much more robust rash with his first-generation EGFR TKI. He’s getting some dry skin and occasional pimples, but nothing compared to what he had before. And so overall, he feels better. He’s not having any GI complaints either. DR LOVE: Oh, that’s interesting. So he actually, in a way, I guess his rash got better. In other words, he had a bad rash on erlotinib, essentially it kind of got better. DR BLUMENSCHEIN: Yes. Correct. DR LOVE: I was really curious — I’ve always been fascinated by the idea of adjuvant targeted therapy, and of course we’re still trying to figure that out. But when I first heard about these third-generation agents, my first thought was, it may be a lot easier to get in, long term, a couple of years, whatever it’s going to be with them, compared to some of the first-generation agents. DR BLUMENSCHEIN: Yes. I think these drugs, in the right populations, are well tolerated. There are some other nuances — for example, with the first-generation drugs we don’t have to worry about cardiac function. And I don’t think I’ve ever seen anybody have myelosuppression. But these drugs do work well in the right patient population. Now in terms of adjuvant treatment, there are a number of studies right now looking at adjuvant therapy with the appropriate TKI or with immunotherapy. And they’re trying to answer that question. Because again, as we mentioned earlier, those questions take years to get addressed. |