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  EP1.14 - Targeted Therapy (ID 204)

  • Event: WCLC 2019
  • Type: E-Poster Viewing in the Exhibit Hall
  • Track: Targeted Therapy
  • Presentations: 1
  • Now Available
  • Moderators:
  • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall

  • 32182

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    EP1.14-28 - A Delphi Consensus on TKI Sequencing in Treating Advanced EGFR-Mutated Non-Small Cell Lung Cancer (NSCLC) (Now Available) (ID 2408)

    08:00 - 18:00  |  Author(s): Thomas Wehler
    • Abstract
    • Slides

    Background
    

    Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are standard of care for first-line therapy in patients with EGFR mutation-positive (EGFR M+) non-small cell lung cancer (NSCLC). However, many patients with EGFR M+ NSCLC eventually acquire resistance to first and second generation TKIs, which commonly occurs with the onset of a T790M mutation.^1,2,3,4 Due to the different resistance mechanisms caused by first- and second-generation TKIs versus third-generation TKIs, and the subsequent availability of targeted treatment options, the sequence of TKIs in EGFR M+ NSCLC must be considered. Previous studies have shown the effectiveness of afatinib followed by osimertinib in delaying later chemotherapy, but there is not yet agreement on wider use of this sequencing strategy. The aim of this survey was to establish a global expert consensus on TKI sequencing strategies in EGFR M+ NSCLC.

    Method
    

    The global panel (7 expert oncologists) reached consensus by a modified Delphi approach (e-surveys). The panellists voted on each statement: disagree, agree, agree with changes (consensus defined as ≥85% agree). Statements without consensus were refined as per suggested changes (through freeform answers to the ‘agree with changes’ option) and re-voted on. Voting was electronic. The project was funded by Boehringer Ingelheim, who had no role in the development of the Delphi questions or the voting process.

    Result
    

    The panel reached consensus that it is important to consider the sequencing of treatments when deciding which EGFR TKI to choose for a patient with advanced EGFR M+ NSCLC, and that optimising TKI sequencing may delay the need for chemotherapy. When choosing the appropriate TKI, the panel reached consensus that a treatment sequence which extends survival, without compromising quality of life, is an important factor when treating patients with advanced EGFR M+ NSCLC.

    The panel also reached consensus that the sequential strategy of afatinib followed by osimertinib is a viable option to prolong the chemotherapy-free period, in particular for the 75% of patients with an Exon 19 deletion (del19) who acquire T790M mutations after first-line treatment.^2,5

    Conclusion
    

    The survey confirms the importance of considering the sequencing of treatments when deciding which TKI to choose for patients with advanced EGFR M+ NSCLC, and provides an expert consensus view on the treatment priorities for this patient population.

    References:

    1. Novello S, et al. Ann Oncol 2016;27(Suppl. 5):v1–27.

    2. Jenkins S, et al. J Thorac Oncol 2017;12(8):1247–56.

    3. Matsuo N, et al. Sci Rep 2016;6:36458.

    4. Lau K-S, et al. Poster presented at ESMO 2016 (Poster 1243P)

    5. Hochmair M, et al. Targeted Oncology 2019

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