Afatinib after progression on osimertinib

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Afatinib after progression on osimertinib

Dear Doctors and Moderators,

  I have been on tarceva for 9 months and after progression and high toxicity moved to Tagrisso. Blood biopsy showed same l858r mutation, but no t790m one. My question is: if I progressed on osimertinib but keeping same original mutation, can I try afatinib?  Or Tagrisso plus afatinib combo? Or Tagrisso plus avastin? Retry tarceva plus Tagrisso combo?

Thank you very much for your assistance.



Jim C Forum Mod...
Jim C Forum Moderator's picture
Afatinib after progression on osimertinib

Hi Vera,


First, let's hope that you don't face the question of progression on Tagrisso for a long time. But if that time comes, it's difficult to say what may be effective in such a third-line setting. We do know that returning to a prior agent such as Tarceva can result in a limited response in some patients. Also, for the most part patients who previously progressed on Tarceva don't often respond well to single-agent Afatinib, although a significant subset of such patients will get a good response to the combination of Afatinib and Cetuximab. The downside of the combination therapy is that it can have a very challenging side effect profile. But in general, the use of a second-generation EGFR TKI is preferred after progression on a first-generation TKI.


Adding Avastin to EGFR TKI therapy has some adherents, but whether it generally provides an added benefit is not established. On the other hand, standard chemotherapy is an option that should not be ignored, as many patients who respond to EGFR TKIs also respond well to chemo.


Hope you have a great response on Tagrisso!


Jim C Forum Moderator



Afatinib after progression on osimertinib

Thank you , Jim for your valuable response.  I just thought probably I can buy more time by switching from Tagrisso to afatinib now when I still have my l858r mutation and not t790m. In addition afatinib can cause t790m mutation later on and then I can get back to Tagrisso.....

May be it doesn’t make any sense.....

warm regards


JanineT Forum M...
Hi Vera, I hope tagrisso has

Hi Vera,


I hope tagrisso has fewing side effects and you're feeling better.  If tagrisso is working then it is your best bet to stay the course.  I get your reasoning but logical thinking too often doesn't work in anti cancer treatment.  If tagrisso is working you wouldn't want to add on another drug that might be helpful down the line(s).


I hope you won't need to make any changes for a long long time,