Notable advances in the field of anti-EGFR therapy
The irreversible ErbB family blocker afatinib and the reversible EGFR TKIs gefitinib and erlotinib have been approved as first-line therapies for treatment of NSCLC patients with EGFR-sensitising mutations. However, resistance frequently develops, which indicates the need for new agents. The EGFR T790M mutation has been identified as the most common resistance mutation. The oral, irreversible, third-generation EGFR TKI osimertinib is active in both sensitising and EGFR T790M resistance mutations. This treatment was evaluated in AURA3, the first randomised phase III trial to compare a T790M-selective EGFR TKI with platinum-based doublet chemotherapy in patients with T790M-positive advanced NSCLC progressing on first-line EGFR TKI therapy . Osimertinib was administered at 80 mg once daily (OD) in the experimental arm (n = 279), while patients in the control arm received pemetrexed plus carboplatin or cisplatin, followed by optional pemetrexed maintenance (n = 140). Stable asymptomatic central nervous system (CNS) metastases were allowed.