The Role of Tyrosine Kinase Inhibitors in Non–small Cell Lung Cancer

Treatment with osimertinib (Tagrisso) in the frontline has been the standard of care for patients with EGFR-mutant non—small cell lung cancer (NSCLC) since the pivotal FLAURA trial. However, more work is needed to introduce first- and second-generation tyrosine kinase inhibitors (TKIs) both alone and in combination to improve the treatment landscape, according to Zosia Piotrowska, MD, MHS.¹

“The question today is, ‘Should we add EGFR TKI to newly diagnosed patients?’ But I think the question should be, ‘Should we add EGFR TKI to all newly diagnosed patients?’” said Piotrowska, instructor at Harvard Medical School and medical oncologist at Massachusetts General Hospital, at the start of her presentation at the 17th Annual Winter Lung Cancer Conference^®.

There are 5 available EGFR TKIs for the treatment of patients with EGFR-mutant lung cancers: gefitinib (Iressa), erlotinib (Tarceva), afatinib (Gilotrif), dacomitinib (Vizimpro), and osimertinib.²

The phase 3 FLAURA trial (NCT02296125) randomized patients with EGFR-mutant NSCLC to receive either osimertinib or comparator EGFR TKIs gefitinib and erlotinib. The median progression-free survival (PFS) was 18.9 months with osimertinib versus 10.2 months with erlotinib or gefitinib (HR, 0.46; 95% CI, 0.37-0.57; P <.001). Based on these data, osimertinib became the first third-generation EGFR TKI approved for this patient population and became accepted as the standard of care for newly diagnosed patients harboring an EGFR mutation.³

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