WCLC 2022 | Exploring neoadjuvant EGFR-TKIs in lung cancer
Julia Rotow, MD, Dana-Farber Cancer Institute, Boston, MA, discusses exploring neoadjuvant EGFR tyrosine kinase inhibitors (TKIs) in lung cancer. Current clinical trials are looking at neoadjuvant third generation TKIs such as in the Phase III NeoADAURA (NCT04351555) trial, investigating osimertinib with or without chemotherapy in the neoadjuvant setting, which may aid in elucidating the clinical applicability of neoadjuvant EGFR-targeted therapy in lung cancer. This interview took place at the IASLC 2022 World Conference on Lung Cancer congress in Vienna, Austria.
Transcript (edited for clarity)
So current clinical trials are looking at the use of neoadjuvant third-generation EGFR-TKIs and comparing them to the use of chemotherapy or TKI plus chemotherapy in that setting since the NeoADAURA trial, which is ongoing. I hope it will give a more definitive answer as to the clinical applicability of neoadjuvant EGFR therapy for this patient population. Then there’s some broad questions of what the goal might be of neoadjuvant TKI therapy...
So current clinical trials are looking at the use of neoadjuvant third-generation EGFR-TKIs and comparing them to the use of chemotherapy or TKI plus chemotherapy in that setting since the NeoADAURA trial, which is ongoing. I hope it will give a more definitive answer as to the clinical applicability of neoadjuvant EGFR therapy for this patient population. Then there’s some broad questions of what the goal might be of neoadjuvant TKI therapy. Is it going to be to improve disease-free survival and overall survival? We certainly hope so. I don’t think we know yet whether adding in the neoadjuvant stage, will that make a difference when we already have three years of adjuvant therapy. There’s other questions about whether this might be able to take patients to less morbid or less extensive surgical resections and lead to better outcomes for patients in that setting, or even convert patients with borderline resectable disease to resectable disease. These are all spaces where drugs with high response rates may have a clinical role.
I think long-term, we’re really interested in neoadjuvant therapy in the hopes that it will give us surrogate endpoints for outcomes. Looking at things like a pathologic response rate or mechanisms of persister disease biology within patients’ individual samples in the hopes that we can use that neoadjuvant therapy to inform our understanding of the patient’s disease and response to therapy to improve their post-surgical management as well.
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