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Integrating Osimertinib in Clinical Practice for Non-Small Cell Lung Cancer Treatment

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Abstract

Treatment of non-small cell lung cancer (NSCLC) is evolving with the use of precision medicine for patients with sensitizing epidermal growth factor receptor (EGFR) mutation. First- and second-generation EGFR tyrosine kinase inhibitors (TKIs) remained the standard of care for patients with EGFR-mutated advanced NSCLC for about a decade. However, treatment resistance eventually develops for most patients who experience initial response to these agents. The most commonly acquired resistance mechanism is the T790M gatekeeper mutation. Poor drug penetration leading to central nervous system (CNS) relapse and dose-limiting toxicities are other concerns. The third-generation EGFR-TKI osimertinib, initially approved as the second-line treatment for patients with T790-mutant NSCLC, demonstrated survival benefits in TKI-naïve EGFR-mutated patients, especially in patients with CNS metastasis. The FLAURA study has shown statistically significant progression-free survival benefit and prolongation of all post-progression outcome endpoints, time to first subsequent therapy, second subsequent therapy, and second progression on subsequent treatment, along with acceptable toxicity and better quality of life outcomes. These data favor osimertinib in the first-line setting for EGFR-mutated NSCLC. This is an important milestone since sequencing the TKI therapy based on accurate prediction of T790M is clinically challenging. In countries like India, T790M testing is not routinely conducted and two-thirds of patients with NSCLC do not receive any second-line therapy. Osimertinib can be administered pragmatically as a first-line therapy. Mature overall survival data from the FLAURA study will be important and could help define the optimal personalized treatment for patients with advanced NSCLC.

Funding: AstraZeneca Pharma India Ltd.

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Acknowledgements

Funding

The preparation of this article and funding of the journal’s article processing charges were supported by AstraZeneca Pharma India Ltd. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Medical Writing Assistance

The authors thank Chinmayee Joshi from Sciformix Technologies Pvt. Ltd., Mumbai for providing medical writing assistance in the development of this manuscript. The authors also thank AstraZeneca Pharma India Ltd. for funding this assistance.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Senthil Rajappa, M Vamshi Krishna, and Prasad Narayanan have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

Data Availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Authors and Affiliations

  1. Medical Oncologist, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, 500034, India

    Senthil Rajappa

  2. Medical Oncology, Apollo Hospitals, Hyderabad, India

    M. Vamshi Krishna

  3. Medical Oncology, Cytecare Hospital, Bengaluru, India

    Prasad Narayanan

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  1. Senthil Rajappa
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Correspondence to Senthil Rajappa.

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Rajappa, S., Krishna, M.V. & Narayanan, P. Integrating Osimertinib in Clinical Practice for Non-Small Cell Lung Cancer Treatment. Adv Ther 36, 1279–1290 (2019). https://doi.org/10.1007/s12325-019-00917-6

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