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13-02-2020 | Oncology | News | Article

Follow-up testing, treatment missing after first-line advanced NSCLC EGFR-TKI therapy

Lynda Williams

medwireNews: US researchers highlight the need for follow-up of stage IV non-small-cell lung cancer (NSCLC) patients who receive first-line EGFR–tyrosine kinase inhibitor (TKI) therapy, finding few patients subsequently undergo testing for the T790M mutation.

Eric Nadler (Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas) and co-workers say data from the US Oncology Network iKnowMedTM electric health records for 2015–2017 show that 98% of 308 EGFR-positive patients received EGFR–TKI therapy, most commonly the first-generation agent erlotinib, but just 26% subsequently received a second-line treatment.

Of the 246 patients given first-line EGFR–TKI without chemotherapy, only 19% were tested for the T790M mutation, a third (34%) of whom were positive for this biomarker.

And only 18% of the first-line EGFR–TKI cohort went on to receive a second-line therapy, most commonly pemetrexed-based chemotherapy (45%), with the second-generation EGFR–TKI afatinib and the third-generation EGFR–TKI osimertinib, which targets the EGFR T790M mutation, given to just 16% of patients each.

Nadler et al report that over a median follow-up of 7.6 months, 20% of the first-line EGFR–TKI cohort continued on their initial treatment, 15% died on or after first-line EGFR–TKI therapy, 12% went onto a second-line treatment, and 53% discontinued EGFR–TKI therapy without any record of further treatment.

“Although multiple generations of EGFR–TKIs are available, after [first-line] EGFR–TKI, the majority of patients may not get subsequent targeted therapy, suggesting the need to understand how to optimize targeted therapy treatment among known EGFR mutation-positive patients,” the team writes in Advances in Therapy.

The authors conclude: “As understanding of resistance mechanisms in mutation-driven NSCLC is rapidly evolving, and as ongoing studies evaluate optimal treatment sequencing, integration of this information into clinical practice will be imperative.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

Adv Ther 2020; 37: 946–954

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