Dr. Garassino on Erlotinib/Ramucirumab Versus Osimertinib in EGFR+ NSCLC

Marina Chiara Garassino, MD, medical consultant, Medical Oncology Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, discusses the combination of erlotinib (Tarceva) and ramucirumab (Cyramza) versus osimertinib (Tagrisso) in EGFR-positive non—small cell lung cancer (NSCLC).

The results of the phase III RELAY trial were presented at the 2019 ASCO Annual Meeting and showed that the combination of erlotinib and ramucirumab reduced the risk of progression or death by more than 40% versus erlotinib alone in patients with treatment-naïve EGFR-positive NSCLC. It may be challenging to decide between the combination and osimertinib alone, given the efficacy of both regimens. Since there are no head-to-head trials, clinicians should take into account patient preference, says Garassino.

However, osimertinib has shown strong activity within the central nervous system. Furthermore, the agent is also effective in preventing the development of brain metastases, adds Garassino. Those data have yet to be shown for the combination. Researchers should carefully consider both data sets when determining which regimen to give patients in the frontline setting. Pending overall survival data and more mature progression-free survival data with the combination, clinicians may have a clearer picture of which regimen is more effective.