Dr. Piotrowska on Eligibility Criteria for Osimertinib in Lung Cancer Treatment

Zofia Piotrowska, MD, MHS, a medical oncologist at Massachusetts General Hospital and an instructor at Harvard Medical School, discusses the patient populations eligible to receive osimertinib (Tagrisso) as treatment for lung cancer.

The results of the FLAURA trial led to Piotrowska giving frontline osimertinib to patients with EGFR exon 19 deletion, L858R, and other sensitizing mutations. When the trial was first published, there was a debate regarding whether it was beneficial to give patients erlotinib or gefitinib upfront. If the patient developed a T790M mutation, that left osimertinib as an option for second-line therapy; however, only about 60% to 70% of patients will develop T7090M. On the other hand, if osimitertinib is given upfront, patients will benefit for ≥19 months. When using the mentality that the best drug should be given upfront, osimertinib should be the frontline treatment according to the FLAURA data, says Piotrowska.

Second-generation EGFR inhibitors are considered for patients with uncommon but still sensitizing EGFR mutations. Afatinib (Gilotrif) is the only FDA-approved therapy for those mutations currently. Data for using osimiertinib on patients with G719, S768I, and other mutations are still being developed, but osimertinib may be used for those patients, as well, concludes Piotrwoska.