GRACE :: Lung Cancer

First-line treatment

Denise Brock

ASCO 2017 – Lung Cancer – Dacomitinib Beats Iressa as First Line Treatment for EGFR Mutation-Positive NSCLC

Share
H. Jack West, MD
Medical Director
Thoracic Oncology Program Swedish Cancer Institute
President & CEO, GRACE
Matthew Gubens, MD
Thoracic Oncologist
Thoracic Surgery and Oncology Clinic
UCSF Helen Diller Family Comprehensive Cancer Center
Jyoti D. Patel, MD
Director Thoracic Oncology
University of Chicago Medicine

 

Drs. H. Jack West, Medical Director of the Thoracic Oncology Program at Swedish Cancer Institute in Seattle, Washington and President and CEO of GRACE, Matthew Gubens, Thoracic Oncologist at the Thoracic Surgery and Oncology Clinic of the UCSF Helen Diller Family Comprehensive Center in San Francisco, California, and Jyoti Patel, Director of Thoracic Oncology at University of Chicago Medicine gathered post meeting to discuss new information from ASCO 2017 regarding lung cancer.   In this roundtable video, the doctors discuss Dacomitinib Beats Iressa as First Line Treatment for EGFR Mutation-Positive NSCLC: New Option or Too Little Too Late?



 

 Please feel free to offer comments and raise questions in our Discussion Forums.


GRACE would like to thank the following sponsors for their support of this program

  
   
                   

 


Denise Brock

ASCO 2017 – Lung Cancer – A Practice Change for ALK+ Lung Cancer Patients, Alecensa for First Line Treatment

Share

 

H. Jack West, MD 

Medical Director 

Thoracic Oncology Program Swedish Cancer Institute

President & CEO, GRACE 

 

Matthew Gubens, MD

Thoracic Oncologist

Thoracic Surgery and Oncology Clinic of the UCSF Helen Diller Family Comprehensive Cancer Center

Jyoti D. Patel, MD

Director Thoracic Oncology

University of Chicago Medicine


Drs. H. Jack West, Medical Director of the Thoracic Oncology Program at Swedish Cancer Institute in Seattle, Washington and President and CEO of GRACE, Matthew Gubens, Thoracic Oncologist at the Thoracic Surgery and Oncology Clinic of the UCSF Helen Diller Family Comprehensive Center in San Francisco, California, and Jyoti Patel, Director of Thoracic Oncology at University of Chicago Medicine gathered post meeting to discuss new information from ASCO 2017 regarding lung cancer.   In this roundtable video, the doctors discuss A Practice Change for ALK+ Lung Cancer Patients, Alecensa for First Line Treatment.


 

 

 


 Please feel free to offer comments and raise questions in our Discussion Forums.


GRACE would like to thank the following sponsors for their support of this program

  
                       

 


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #33 Current Standards and Leading Options for First-line Treatment of EGFR Mutation-Positive NSCLC

Share
 
GRACE Cancer Video Library - Lung

 

We continue to provide informational videos for our Spanish speaking community and welcome Dr. Luis Raez, MD FACP FCCP, Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University.  Dr. Raez joined GRACE to discuss the basics of lung cancer.  In this 33rd video for the Spanish lung cancer video library, Dr. Raez discusses current standards and leading options for first-line treatment of EGFR mutation-positive NSCLC.


 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
download transcripts
 

Estándares actuales y opciones líderes para el tratamiento de primera línea de una mutación positiva del receptor del factor de crecimiento epidérmico (EGFR) en cáncer pulmonar de células no pequeñas.

 Current standards and leading options in first line treatment for a positive mutation in epidermal growth factor receptor (EGFR) in non-small cell lung cancer

 Dr. Luis Raez, MD FACP FCCP

Chief of Hematology/Oncology and Medical Director, Memorial Cancer Institute,
Clinical Associate Professor of Medicine, Florida International University

 

Spanish TRANSCRIPT

¿Cuál es el estándar o cuál es el tratamiento convencional para pacientes que tienen mutaciones EGFR? Eso creo que todos lo sabemos muy bien, porque hace 5 años que lo hacemos. Tenemos la suerte que cuando tenemos un paciente con mutaciones EGFR también tenemos tres o cuatro fármacos aprobados.

La primera es gefitinib, la segunda erlotinib, la tercera es afatinib, y hay países asiáticos que tienen icomatinib. Hay obviamente muchos más inhibidores de las tirosinas cinasa que están en desarrollo en muchos países. Pero en general estos son los agentes que tenemos, muchas veces la elección de estos agentes depende de la tradición. Por ejemplo, en el hemisferio oeste del mundo (Europa y Norte América), el único fármaco disponible era erlotinib y la mayoría de gente usa esta. En Asia, en 23-24 países gefitinib ha estado disponible por muchos años y están acostumbrados a hacer eso. Los mismo con icomatinib que se desarrolló en China e India. 

Muchas veces la elección de la droga depende de lo que uno está acostumbrado a hacer. Hay muy pocos estudios, solamente hay uno en carcinoma de células epidermoide que prueba que un fármaco puede ser mejor que otro. En el caso de afatinib contra erlotinib que hay un mejor beneficio con afatinib. En general también depende mucho de la compañía de seguros y otros factores para ver que agente se va a usar.

También la toxicidad es diferente, algunos de ellos son menos tóxicos que otros. Me refiero por ejemplo a las erupciones de la piel y a las diarreas. En general, las drogas más potentes como afatinib, que son inhibidores irreversibles de la tirosina cinasa, tienden a dar más diarreas y erupciones por lo que muchos médicos piensan que son mejores y las usan. Y hay otros médicos que piensan que no y no los usan porque también recuerden que hay pacientes mayores que de repente no van a tolerar las erupciones y la diarrea, por lo que tenemos que usar la toxicidad para ver que fármacos se van a usar en cada caso.


 

English TRANSCRIPT

What is the standard treatment for patients with EGFR mutations? I think we all know it pretty well because we’ve been doing it for 5 years. We have been lucky to have patients with EGFR mutations and also have 3 to 4 approved drugs.

The first one is gefitinib, the second is erlotinib, the third one is afatinib, and in Asian countries they have icomatinib. There are obviously more tyrosine kinase inhibitors that are being developed in many countries. But in general, these agents are sometimes selected because of tradition. For example, in the western hemisphere (Europe and North America), the only approved drug was erlotinib, so most people use it. In 23-24 countries in Asia, they have been using gefitinib for many years and they are used to their reaction. The same with icomatinib that was developed in China and India.

Many times, the drug of choice depends on what the patient is used to. There are few trials, only one in epidermal cells cancer, that proves that a drug can be better than another one. In the case of afatinib and erlotinib, there a more benefits with afatinib. In general, it also depends on the insurance company and other factors to see which agent to use.

The toxicity is different, some of them are less toxic than others, but the effects are only skin rash and diarrhea. In general, the more powerful drugs like afatinib, which are irreversible tyrosine kinase inhibitors, give more rashes and diarrhea, so physicians think that it’s better and they use it more. In contrast, there are other doctors that think the side effects are not good, so they don’t use them, especially in elderly patients that cannot tolerate skin rashes or diarrhea. As you can see, we use toxicity to see which drugs are going to be used in each case.


More Evidence from Asia on Where EGFR TKIs Fit into NSCLC Treatment

Share

As more and more oncologists become aware of the importance of testing for at least the EGFR mutation in tumor, and soon, perhaps, in blood, it seems likely that more patients will have their first systemic treatment for advanced non-small cell lung cancer (NSCLC) be an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), usually Tarceva (erlotinib), until Iressa (gefitinib) is re-approved (perhaps). This is because the presence or absence of the mutation seems more important than clinical features in predicting a benefit from the TKI, as Dr. West described in the wake of the evidence from the IPASS trial. In that regard, a recent paper from a group of investigators in Taiwan discusses what second-line treatment should be considered after progresssion following first line Iressa in patients with advanced NSCLC. A total of 195 patients were included in this retrospective analysis, of whom 95 had tissue for testing for the EGFR mutation (61 with a mutation, 34 without). Although these findings may not be directly transferable to a North American or European population who would be receiving the very similar TKI, Tarceva, they are still of some interest.

Those with the EGFR mutation who progressed while on Iressa got a greater survival benefit with Gemzar (gemcitabine) plus a platinum-containing regime than any other regimen, including single-agents Navelbine (vinorelbine), a taxane (such as Taxol (paclitaxel) or Taxotere (docetaxel)), or any of those combined with a platinum, or Tarceva was given in some patients. However, it is of interest that none received an Alimta (pemetrexed)-containing regimen, so this remains an unknown. On the other hand, those patients who did not have an EGFR mutation did just as well with a single chemotherapeutic agent as with a doublet containing a platinum, and no one treatment emerged as especially better than another.

Continue reading


Cetuximab (Erbitux) for Advanced NSCLC: Promising Results, But is it Ready for Prime Time?

Share

There has been quite a lot of discussion recently about the EGFR tyrosine kinase inhibitors (TKIs), erlotinib (Tarceva) and gefitinib (Iressa). Recently however the final results of the FLEX trial were published in The Lancet, bringing attention back to one of the antibodies against EGFR, cetuximab (Erbitux). Dr. West had previously written about the early presentation of results from this trial in a post after the ASCO meeting last year.

As a background, cetuximab is a monoclonal antibody that is given through the vein weekly. It has been shown to prolong life in combination with chemotherapy for patients with head and neck cancers, as well as for patients with colon cancers. The FLEX (First-Line ErbituX in lung cancer) study was a large randomized trial evaluating whether the combination of cetuximab with chemotherapy would prolong life for patients with NSCLC.

This study enrolled patients with NSCLC whose tumors showed staining by immunohistochemistry (IHC) for EGFR, even if it was only one tumor cell. Patients must have incurable NSCLC and could not have previously received chemotherapy. Of 1688 patients with tumors tested, 1442 demonstrated at least one cell positive for EGFR. 1125 patients were ultimately randomized to receive either six cycles of chemotherapy with cisplatin and vinorelbine (Navelbine) or the same chemotherapy with weekly Erbitux. Patients in the Erbitux arm who didn’t show progression after six cycles then continued to receive it weekly until progressive disease or until they experienced toxicity requiring stopping the drug.

Continue reading


Ask Us, Q&A
Lung/Thoracic Cancer Expert Content

Archives

Share

GRACE Cancer Video Library - Lung Cancer Videos

 

2015_Immunotherapy_Forum_Videos

 

2015 Acquired Resistance in Lung Cancer Patient Forum Videos

Share

Join the GRACE Faculty

Breast Cancer Blog
Pancreatic Cancer Blog
Kidney Cancer Blog
Bladder Cancer Blog
Head/Neck Cancer Blog
Share

Subscribe to the GRACEcast Podcast on iTunes

Share

Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon

Subscribe to
GRACE Notes
   (Free Newsletter)

Other Resources

Share

ClinicalTrials.gov


Biomedical Learning Institute

peerview_institute_logo_243