Tarceva after Afantib - 1290364

Hi Ilan,

Welcome to Grace. I'm sorry it took a while to answer your question. If your mother has acquired the T790M mutation data suggests tagrisso as her next tx. T790M is a mutation most often acquired while taking a 1st or 2nd line TKI (either tarceva, afatinib or iressa). Once this mutation is acquired these drugs no longer work on that tumor. It is possible that some of the tumors have the new mutation while others don't and this looks like slow progression or progression in just one or 2 places. In that case local therapy may be a option then continue with afatinib or even change to tarceva.

There is little to no efficacy found when moving from 1st to 2nd gen TKI.

The studies that 1st suggested TKI worked differently on exon 19 and L858R did not hold up over the course of the trial and now appears to have even efficacy. In the post Dr. West explains, "One more important finding was that despite some earlier work suggesting that Gilotrif may not be a strong choice for patients with an L858R substitution, the results were better for Gilotrif in the patients with both common activating mutations and no trend of different results (though the patients with an exon 19 deletion had a median PFS 1-2 months longer than the L858R substitution population with either EGFR TKI). We can conclude that Gilotrif isn’t a treatment only for patients with an exon 19 deletion." "But the comparison in LUX-Lung-7 is of Gilotrif vs. Iressa. in the US, the overwhelming leading first line treatment for EGFR mutation-positive NSCLC is Tarceva. Can we assume that Gilotrif is definitely better than Tarceva? I’d say no.The very poor data we have to compare them is mixed but has at least suggested to me that Tarceva is perhaps marginally superior to Iressa, so I wouldn’t presume that Tarceva will fall closer in efficacy results to Iressa than Gilotrif."
http://cancergrace.org/lung/2016/01/12/ll7-esmo-asia15/

I hope this is helpful.
All best,
Janine