Can EGFR positive patients be treated by immunotherapy? - 1271881

dando
Posts:11

Hi
I returned from a seminar (in Tel Aviv, Israel) about identefication and treatment methods for lung cancer.
One of the lecturers mentiond that "EGFR + patients cannot be treated by immunotherapy".
I am concerned with this statement. My wife have NSCLC EGFR (Exon 21) and is being treated successfully with Tarceva for 8 months (First line treatment). But there are signs that she may need a second line treatment.
I would appreciate very much your comment on this statement.

Regards

Dan Lando

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Reply # - November 18, 2015, 05:57 AM

JimC
Posts: 2753

Hi Dan,

From the early data, it appears that immunotherapies are not as effective for patients who have driver mutations such as EGFR. Response rates for first line treatment with immunotherapies for such patients are low, but there are ongoing trials testing the efficacy of a combination of an EGFR inhibitor and an immunotherapy agent. This subject is discussed in a GRACE podcast here.

That doesn't mean that EGFR patients who develop resistance are without options. There are several third generation EGFR inhibitors currently being tested in clinical trials, and in fact in the past week the first of them, Tagrisso (osimertinib, AZD9291), received FDA approval for patients with T790M resistance. You can read about the approval here.

JimC
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Reply # - November 18, 2015, 01:59 PM

dando
Posts: 11

JimC, thank you very much for the information.
Yes, the news about the tagrisso is great!!
Still it is disappointing to know that a new branch of treatment is currently blocked for EGFR + patients.
Does this behaviour applies to all checkpoint inhibitors or specifically to PD-1?
Are there other promising immunoterapic treatments (other then checkpoint inhibitors)?

Regards

Dan

Reply # - November 18, 2015, 10:27 PM

dando
Posts: 11

Hi
I realize that the same subject is discussed in another topic- "When to begin exploring immunotherpy"

Dan

Reply # - November 19, 2015, 04:19 PM

catdander
Posts:

The new checkpoint inhibitors are the only new immunotherapies at this time.
EGFR TKIs are front line treatments for those with the mutation. 2nd line for these people would depend on whether or not they show the T790M mutation, if so the newly approved Tagrisso (osimertinib, AZD9291) would be the standard. After those treatments choices are immunotherapy and chemo. The short video linked to below talks about toxicity with immunotherapies which are usually quite a bit easier to take then chemo. It may make sense to try them before chemo even if they aren't as likely to work in those with an egfr mutation because if they work they can work for long periods of time with much less toxicity.

http://cancergrace.org/lung/2015/11/15/wclc_2015_immune_checkpoint_inhi…

Good luck Dan to you and your wife,
Janine

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