New Biological Insights and Recent Therapeutic Advances in the Management of Lung Cancer: A Clinical Investigator Think Tank
Role of afatinib for patients with disease progression on erlotinib
1:44 minutes.
TRANSCRIPTION:
DR LOVE: Jeff, we have seen consistently, and I think maybe in even one of the conferences that you attended, when we ask oncologists in practice about this issue of what to do with a patient who is having progressive disease on erlotinib, one answer that we always see in not a small number of people, maybe 20% or 30%, is afatinib. Is that the wrong answer? DR OXNARD: The standard of care in this space is complicated and dynamic. I find in my practice that patients can get a lot of distance out of continued erlotinib. Some patients are uncomfortable with that. Switching to afatinib is not an unreasonable strategy. I don’t think it’s going to get you a response. I think the response rate in this space of prior TKI has been low. We know that from the randomized afatinib versus placebo trial. It didn’t cause a lot of responses. Might you get some PFS? Maybe. Certainly it’s not going to be as effective as chemo, and it’s not going to be as effective as one of the new drugs. DR LOVE: How often, if at all, do you do that? I mean, I know you have trials available. But you said, “I think it’s not unreasonable.” Is that something you do? DR OXNARD: No, it’s not part of my practice. I don’t escalate the erlotinib to higher dose, something some other people do, and I don’t give afatinib. I sometimes can get distance out of the erlotinib as it is, as they slowly progress, until I find the next thing. And I find most of my patients are comfortable with that because I’m comfortable doing that. Other patients want to try something else. And if that’s the case, I don’t think you’re going to get a lot of months out of afatinib, but it’s not unreasonable to try. |