Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 7Treatment options after disease progression on osimertinib
2:25 minutes.
TRANSCRIPTION:
DR LOVE: What do you do after osimertinib? So for a patient that, say, goes through erlotinib, gefitinib, afatinib, then they get osimertinib, then they have disease progression, I’ve heard, quote, now they might respond back to the original one erlotinib? Is that right? DR MOK: Right. That is a theory, because the osimertinib failure, approximately 20% — small study — that they may have a mutation called a C797S mutation. The C797 is actually the binding site of the third-generation TKI. If you have a mutation there, that’s no longer binding to it. So in principle, in a certain context, the trans of the C797S with T790M, they may, actually, in the cell-line study, respond to first generation. But that has never been proven in the clinical realm. So at this moment we don’t know, but actually Nature just out, Pasi Janne’s group had actually proposed a new drug that potentially can inhibit the C797S mutation. DR LOVE: Hmm. A TKI? DR MOK: It is a TKI. It’s a new type of TKI but then is actually only some preclinical model. And that is just a very nice paper, come out the possibility of a new class of drugs. DR LOVE: Do you think that targeted therapy alone is going to cure anybody? DR MOK: See, cure is a “luxury” term. I mean, we’ll never cure a life, anyway. We just have to make sure the patient lives as long as they can with the maximum quality they can. So to me, you can use the word cure, but if you live long enough and good enough, that’s fine with me. DR LOVE: Yes, but I mean, like, infections. You can get rid of them, theoretically. And I almost think sometimes we have this antimicrobial approach to cancer sometimes. DR MOK: We are. We are. DR LOVE: And I kind of wonder if that really is making sense for — DR MOK: So for that, let me just share some of the cases that I have in Asia. I got 1 patient who actually had been on TKI for 9 years and that has no disease. Are you going to stop it? So I actually proposed to say, “Why don’t you stop the drug and see what happens?” But she says, “No,” she doesn’t want to stop the drug. DR LOVE: But she’s on gefitinib? DR MOK: She’s on gefitinib for 9 years. And then she just doesn’t want to stop the drug. And that is one thing that keeps her alive. That’s what she thought. So is she cured, now that she’s lived 9 years and there’s no detectable disease? |