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WCLC 2022 | Neoadjuvant EGFR TKI trials in NSCLC

Julia Rotow, MD, Dana-Farber Cancer Institute, Boston, MA, discusses the use of neoadjuvant EGFR TKI, an emerging strategy in the management of non-small cell lung cancer (NSCLC), highlighting the importance of moving novel approaches into earlier treatment lines to improve patient outcomes. Dr Rotow also touches on the NeoADAURA trial (NCT04351555) which will evaluate neoadjuvant osimertinib with or without chemotherapy versus chemotherapy alone prior to surgery, in patients with resectable stage II-IIIB N2 EGFR mutation-positive NSCLC. This interview took place at the IASLC 2022 World Conference on Lung Cancer congress in Vienna, Austria.

Transcript (edited for clarity)

I’m happy to be speaking here today at the conference on an education session, on the use of neoadjuvant EGFR TKI therapy. This is I think an emerging therapeutic strategy, which does not currently have an FDA approval. We’ve noticed some interesting data in the past year or two, looking at bringing some of our advances from the metastatic setting into the neoadjuvant space. The most exciting data of course, has been with the use of immunotherapy with chemo and the Checkmate 816 study...

I’m happy to be speaking here today at the conference on an education session, on the use of neoadjuvant EGFR TKI therapy. This is I think an emerging therapeutic strategy, which does not currently have an FDA approval. We’ve noticed some interesting data in the past year or two, looking at bringing some of our advances from the metastatic setting into the neoadjuvant space. The most exciting data of course, has been with the use of immunotherapy with chemo and the Checkmate 816 study. We’ve also seen interesting data using EGFR TKI therapy in the adjuvant setting for this earlier stage patient population. The question is, can we move that adjuvant data into the neoadjuvant space and generate better patient outcomes? This was looked at before, so we’ll talk about some of the early stage EGFR TKIs or early generation EGFR TKIs, which have been used in new adjuvant trial designs in the past.

These have shown varying response rates, but usually around 50% to 60%, as well as pathologic response rates, which have outperformed chemotherapy, where there are randomized comparisons, but have not yet met the kind of response rates we’ve seen with neoadjuvant chemo IO for our EGFR wild-type patient population.

The interest now is whether we can do randomized trials using third generation EGFR TKI, so our modern EGFR TKIs like Osimertinib in that neoadjuvant space and see if we can demonstrate benefit. That’s the subject of the NeoADAURA, which is ongoing looking at the use of osimertinib versus osimertinib plus chemotherapy in that preoperative setting.

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