Corey J. Langer, MD, FACP of the University of Pennsylvania discusses how in EGFR Activating Mutations, Osimertinib is now the Standard of Care. FDA is often behind clinical practice. In this case, the NCCN has already cited the important role of osimertinib based on the FLAURA trial, first sign treatment in all EGFR activating mutations. Since the end of 2017, osimertinib is now the standard of care in the front-line therapy of non-small-cell patients with activating EGFR mutation.
What to use in the second line is a bit of a dilemma. This will be based increasingly on tissue and plasma testing when looking for mutations associated with acquired resistance. Its still an open field of inquiry and there is no standard. The default standard for this population when TKIs are no longer working is chemotherapy. Then, immunotherapy is for third or fourth line. In this case, the chemotherapy regimen is better in the salvage therapy on the EGFR mutated non-small-cell than immunotherapy.