In metastatic EGFRm non-small cell lung cancer (NSCLC)
Treat the driver of disease
In metastatic EGFRm NSCLC, EGFR TKIs are the first-line recommended option, independent of PD-L1 expression1
Dear Amy Gonsuron,
Without a full biomarker profile, patients may not receive optimal treatment.
When considering molecular targets, were you aware that EGFR mutation status and PD‑L1 expression are not mutually exclusive? Studies show that up to 70% of EGFRm patients also express PD-L1 (TPS ≥1%).2-5
There is no evidence to support first-line treatment with IO in EGFRm patients
Pivotal first-line IO trials have excluded treatment-naïve EGFRm patients6-13
Eight of the most recognized IO trials DID NOT allow treatment-naïve EGFRm patients6-13*
Several guidelines recommend testing for appropriate genetic targets and treating with targeted therapy based on test results1,14,15
- The NCCN Guidelines® do not endorse specific testing modalities or techniques for biomarker tests
IO is not approved or indicated in the first-line EGFRm NSCLC setting16-18
After treatment with an EGFR TKI, IO is an option in EGFRm patients (IO/chemo, or IO after a subsequent chemo combo)1,15
* KEYNOTE-189, KEYNOTE-021 Cohort G, KEYNOTE-024, KEYNOTE-042, CHECKMATE 026, CHECKMATE 227, IMpower130, IMpower150. In the IMpower130 and IMpower150 trials, EGFRm positive patients were allowed only after progression on EGFR-TKI therapy.13
As part of our dedication to the advancement of precision medicine, we are also pleased to share with you, a new online resource designed to help you optimize biomarker testing at your oncology practice.
EGFRm, EGFR mutation-positive; IO, immunotherapy; TPS, tumor progression score.
References: 1. Brahmer JR, Govindan R, Anders RA, et al. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of non-small cell lung cancer (NSCLC). J Immunother Cancer. 2018;6(1):75. 2. Akamine T, Takada K, Toyokawa G, et al. Association of preoperative serum CRP with PD-L1 expression in 508 patients with non-small cell lung cancer: a comprehensive analysis of systemic inflammatory markers. Surg Oncol. 2018;27(1):88-94. 3. Liu SY, Dong ZY, Wu SP, et al. Clinical relevance of PD-L1 expression and CD8+ T cells infiltration in patients with EGFR-mutated and ALK‑rearranged lung cancer. Lung Cancer. 2018;125:86-92. 4 . Yoneshima Y, Ijichi K, Anai S, et al. PD-L1 expression in lung adenocarcinoma harboring EGFR mutations or ALK rearrangements. Lung Cancer. 2018;118:36-40. 5. D’Incecco A, Andreozzi M, Ludovini V, et al. PD-1 and PD-L1 expression in molecularly selected non-small-cell lung cancer patients. Br J Cancer. 2015;112(1):95-102. 6. Reck M, Rodríguez-Abreu D, Robinson AG, et al; KEYNOTE-024 Investigators. Pembrolizumab versus chemotherapy for PD-L1–positive non–small-cell lung cancer. N Engl J Med. 2016;375(19):1823-1833. 7 . Study of MK-3475 (pembrolizumab) versus platinum-based chemotherapy for participants with PD-L1-positive advanced or metastatic non-small cell lung cancer (MK-3475-042/KEYNOTE-042). Accessed January 9, 2019. 8. Langer CJ, Gadgeel SM, Borghaei H, et al; KEYNOTE-021 Investigators. Carboplatin and pemetrexed with or without pembrolizumab for advanced, non-squamous non-small-cell lung cancer: a randomised, phase 2 cohort of the open-label KEYNOTE-021 study. Lancet Oncol. 2016;17(11):1497-1508. 9 . Broderick JM. Frontline pembrolizumab combo improves survival in phase III NSCLC trial. Published January 16, 2018. Updated April 16, 2018. Accessed January 9, 2019. 10. Carbone DP, Reck M, Paz-Ares L, et al; CheckMate 026 Investigators. First-line nivolumab in stage IV or recurrent non–small-cell lung cancer. N Engl J Med. 2017;376(25):2415‑2426. 11. Hellmann MD, Ciuleanu TE, Pluzanski A, et al. Nivolumab plus ipilimumab in lung cancer with a high tumor mutational burden. N Engl J Med. 2018;378(22):2093-2104. 12 . EU Clinical Trials Register. A phase III clinical study to evaluate the efficacy and safety of atezolizumab in combination with carboplatin + nab‑paclitaxel compared with carboplatin + nab-paclitaxel in patients with stage IV non-squamous non-small cell lung cancer. EudraCT number 2014-003206-32. Accessed January 28, 2019. 13. Kowanetz M, Socinski MA, Zou W, et al. IMpower150: efficacy of atezolizumab plus bevacizumab and chemotherapy in 1L metastatic nonsquamous NSCLC across key subgroups. Presented at: AACR; April 14-18, 2018; Chicago, IL. 14 . Kalemkerian GP, Narula N, Kennedy EB, et al. Molecular testing guideline for the selection of patients with lung cancer for treatment with targeted tyrosine kinase inhibitors: American Society of Clinical Oncology endorsement of the College of American Pathologists/International Association for the Study of Lung Cancer/Association for Molecular Pathology Clinical Practice Guideline update. J Clin Oncol. 2018;36(9):911-919. 15. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines® ) for NSCLC V.3.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed January 22, 2019. To view the most recent and complete version of the guideline, go online to NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 16. Tecentriq [package insert]. South San Francisco, CA: Genentech, Inc; 2018. 17. Keytruda [package insert]. Whitehouse Station, NJ: Merck & Co., Inc; 2018. 18. Opdivo [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2018.
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