NOTE: DURING TTLC 23, DRS. BALAZS HALMOS AND MARK SOCINSKI PRESENTED THE EVIDENCE FOR AND AGAINST CONTINUED TYROSINE KINASE INHIBITORS USE WITH CHEMOTHERAPY FOR EGFR-POSITIVE PATIENTS WITH DISEASE PROGRESSION.
EGFR tyrosine kinase inhibitors (TKIs) have been integrated into early treatment for non-small cell lung cancer (NSCLC) patients with EGFR mutations. Upon disease progression, some clinicians suggest that continued TKI use in conjunction with chemotherapy is the optimal strategy for patient care. Others contend there is a lack of conclusive evidence to recommend this approach, particularly with the added toxicity and financial burden this treatment can place on patients.
During the 2023 Targeted Therapies of Lung Cancer Meeting in Santa Monica, California, two experts debated the pros and cons during “Session 1: Targeted Therapies—EGFR, HER2 and MET.” Registered attendees can view the session on-demand.
Balazs Halmos, MD, associate director for clinical science and chief of thoracic/head & neck oncology at Montefiore Einstein Cancer Center, New York, argued in favor of continued TKI use and Mark Socinski, MD, who is executive medical director of AdventHealth Cancer Institute, Orlando, questioned the evidence for TKI use with chemotherapy upon disease advancement.
In advocating for TKIs, Dr. Halmos cited research that demonstrated their multifaceted utility. He highlighted multiple studies that recommend continued TKI application for patients with oligoprogressive disease,1 MET amplification,2 and central nervous system disease.3 He also cited an ongoing frontline study4 measuring the benefit of chemotherapy with osimertinib versus chemotherapy plus placebo in patients with EGFR mutated advanced NSCLC. While this study is still in progress, and results are not expected until 2024, Dr. Halmos said he is confident they will support his argument.
“Osimertinib is really like chocolate if you think about it,” Dr. Halmos said. “It goes with everything: radiation, targeted therapy, and chemotherapy.”
Unconvinced, Dr. Socinski argued that there is not yet sufficient evidence to recommend TKIs after disease progression. He cited the absence of randomized trial data and pointed out that the National Comprehensive Cancer Network did not recommend this approach in its guidelines. Read more.