Dr. Nathan Pennell, Cleveland Clinic, describes other options for treatment of acquired resistance, including chemotherapy, ablation with SBRT and a combination of Gilotrif and Erbitux.
Dr. Jeffrey Bradley, Radiation Oncologist at Washington University in St. Louis, provides trial evidence showing that patients may not benefit from high dose chest radiation therapy vs. standard dose therapy.
Drs. Jack West and Greg Riely field questions about which treatments should EGFR lung cancer patients consider when their cancers progress.
Dr. Jack West suggests that progression in T790M-negative EGFR lung cancer patients may not require a change in therapy. In this video he details what should go into the decision to modify treatment for those patients.
Dr. David Spigel, Sarah Cannon Cancer Center, outlines treatment options for squamous lung cancer.
The course of Erbitux (cetuximab), the antibody to EGFR, in lung cancer over the last years has been controversial but overall underwhelming. Added to carboplatin and Taxol (paclitaxel) or Taxotere (docetaxel) as first line therapy in a North American phase III randomized trial, it was associated with a marginal improvement in progression-free survival depending on who did the assessement, but no improvement in overall survival.
RTOG 0617: Stunningly Worse Survival for High Dose Radiation in Locally Advanced NSCLC, but Carbo-Taxol Has Never Looked Better
The Radiation Therapy Oncology Group (RTOG) has been working on a large randomized trial in patients with stage III, locally advanced, unresectable NSCLC that asked two key questions:
1) is the best dose of radiation the "old" standard of 60 Gray (Gy), over about 6 weeks, or a higher dose of 74 Gy that has been found to be feasible?
2) Is there a value in adding weekly Erbitux (cetuximab), the antibody to the epidermal growth factor receptor (EGFR), along with weekly carboplatin/Taxol (paclitaxel) and concurrent chest radiation therapy (RT)?
More Info on the Correlation of Rash with Outcome on EGFR Inhibitors: My Changing View in Light of the TOPICAL Trial
There's been a theme with the inhibitors of the epidermal growth factor receptor (EGFR) -- both oral tyrosine kinase inhibitors (TKIs) and IV monoclonal antibodies -- that the patients who demonstrate good results with these agents tend to get a rash, while the patients who don't get a rash do poorly.