Dr. Wakelee Discusses EGFR TKIs in Lung Cancer

Heather Wakelee, MD associate professor of Medicine (Oncology) at Stanford University Medical Center, discusses EGFR tyrosine kinase inhibitors (TKIs) in lung cancer.

There are currently 3 FDA-approved drugs in the first-line setting, and there is a fourth that is under consideration. It is standard of care to check for EGFR mutations in patients who are newly diagnosed with advanced-stage lung cancer, especially adenocarcinoma. If one of the activating mutations is found, especially the 2 most common, exon 19 deletion or L858R, then physicians can choose from erlotinib (Tarceva), gefitinib (Iressa), or afatinib (Gilotrif). They are all FDA approved and are associated with high response rates and reasonable progression-free survival, Wakelee says.

According to Wakelee, it has been difficult to distinguish between these agents in the past. More recently, there has been a frontline trial that looked at the third-generation drug osimertinib (Tagrisso), which has been approved to be given to patients after they have had one of the other 3 agents, and if the resistance mechanism is T790M. There is debate regarding osimertinib, but it works incredibly well against the common activating mutations, such as 17p deletion and L858R, says Wakelee.