New Biological Insights and Recent Therapeutic Advances in the Management of Lung Cancer: A Clinical Investigator Think Tank
Nonresearch use of EGFR tyrosine kinase inhibitors as adjuvant therapy for patients with sensitizing EGFR mutations
1:52 minutes.
TRANSCRIPTION:
DR LOVE: Are there situations where you would use an adjuvant EGFR TKI right now? DR KRIS: I agree that survival is the issue here. And actually I will call it something different and talk about curability. I think the first thing we have to be insistent on is that everybody gets chemo in these situations. Everybody who’s a candidate for chemo should get chemo and everybody who’s a candidate for chemo should get cisplatin-based chemo, because that’s the only curative regimen. There is no curative regimen without cisplatin. I think that’s still true. The second thing is, if you have N2 disease, you need radiation as well. I think that message just has to get out. There are a couple of papers, actually, in this JTO, looking at the huge amount of data, actually, that says that radiation improves survival in these patients. I’m totally moved in this direction by the GIST data. It’s a standard of care that patients with GIST get imatinib, first to improve PFS. They’re going from 1 to 3 years, they improve PFS more. And out of 3 years, they improve survival. That’s the data. And I see no reason that we can’t have the same happen here. The RADIANT blew it. If you took the nonrandomized data, you needed about only 250 mutant patients to know if erlotinib would work or not. And they chose to ignore the data that EGFR mutation could be predictive of benefit and they had a trial that couldn’t possibly prove that. And again, we were part of SELECT. We’re part of the afatinib trial now. I try to put people on that trial. But if I do not have a trial, I treat them. |