JanneBOA Targeted Therapy after ASCO20107.3.10.pptVIP

Pasi A. J?nne, M.D.,Ph.D. Lowe Center for Thoracic Oncology Dana Farber Cancer Institute EGFR Inhibitors First line use Should be based on EGFR genotype Only EGFR mutant patients should be offered EGFR TKIs EGFR wild type patients should receive chemothearpy EGFR inhibitors can have adverse or no effect Unselected patients Patients with poor performance status How to Improve Outcome of First Line EGFR TKI Therapy ? Add chemotherapy to EGFR inhibitors CALGB 30406 No clear signal that adding chemotherapy to an EGFR TKI is any better than an EGFR TKI alone in EGFR mutant NSCLC Use an alternative EGFR inhibitor BIBW2992 or PTreatment of First Line Stage IV EGFR mutant NSCLC Standard of care Single agent gefitinib or erlotinib No clear clinical benefit from Addition of chemotherapy to EGFR TKI Second generation EGFR TKI EGFR Inhibitors beyond first line therapy Selection for EGFR mutations Therapeutic options more limited Patient selection still has an impact on outcome Targeted Therapy for Lung Cancer in 2010 Important to identify Patients with EGFR mutations ALK translocations Clinical studies ongoing for patients with other genotypes * * Targeted Therapy for Lung Cancer After ASCO 2010 International multicenter randomized phase III study of 1st line erlotinib followed by 2nd line cisplatin + gemcitabine vs. 1st line cisplatin + gemcitabine followed by 2nd line erlotinib in advanced NSCLC. The TORCH trial C.Gridelli1, F.Ciardiello2, R.Feld3, C.Butts4, V.Gebbia5, G.Genestreti6, A.Favaretto7, R.Wierzbicki8, C.Gallo2, F. Perrone9 on behalf of the TORCH Investigators. 1S.G.Moscati Hospital, Avellino, Italy 2Second University, Napoli, Italy 3Princess Margaret Hospital, Toronto, Canada 4Cross Cancer Institute, Edmonton, Canada 5La Maddalena Clinic, Palermo, Italy 6 Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Forlì, Italy 7Istituto Oncologico Veneto, Padova, Italy 8Durham Regional Cancer Centre, Oshawa, Canada, 9National Cancer I