Terapia di III^ linea
nel NSCLC
Giovenzio Genestreti MD
U.O.C. Oncologia Medica
AUSL Bologna
Sommario
Inibitori EGFR
ERLOTINIB
C22H23N3O4
OSI-774
PAZIENTI NON
SELEZIONATI
Grazie per l’attenzione
Qual è l’aderenza alle
Linee Guida?
Third-line Treatment
Clinical Practice Points
• More than 2 lines of treatment in clinical practice will
probably be higher, compared with some years ago
• Erlotinib is the only drug with evidence of efficacy as
third-line treatment in patients with advanced NSCLC not
eligible for further chemotherapy
• Most patients were treated with a cytotoxic agent and
only a small proportion received erlotinib
III^ Linea:
a chi?
Fattori Prognostici
• Female Gender
• Never Smoker
•
•
•
•
•
PS 0-1
No weight loss
Only lung mts
< 2 mts sites
EGFR / ALK
Paul et al. ASCO 2015, Boente et al. WLCC 2015, Carcereny et al. WLCC 2015
III^ Linea:
Erlotinib?
Mutated EGFR:
I^ line
TKI vs Chemotherapy
EURTAC Rosell R. Lancet Oncol 2012
OPTIMAL, CTONG-0802 Zhou C. Lancet Oncol 2011
Maemondo M. et al. NEJM 2010
WJTOG3405 Mitsudomi T. Lancet Oncol 2010
IPASS Mock TS. NEJM 2009
LUX-LUNG 3 Yang JCH. ASCO 2012
LUX-LUNG 6 Wu YL. Lancet Oncol 2014
Erlotinib nei NSCLC con
EGFR WT o Unknwon in
III^ Linea funziona?
II^-III^ Linea ERL vs CHT
in WT/Unknown NSCLC
Karampeazis A. et al. Cancer 2013
Kawaguchi T. et al. JCO 2014
Conclusioni
CHT (Not Evidence Based)
• Dopo II^ linea: Best Supportive Care
ERLOTINIB
• Fattori prognostici e predittivi hanno:
MODIFICA ALGORITMO DECISIONALE
• Aumento delle III^ linee?
• Importanza di studi e arruolamento
CONFIRMER
Trial Design
538 pts
• PS 0-1 vs 2
• Sq. vs NO-Sq.
• EGFR:
WT vs Unkown
•
R
A
N
D
O
M
1:1
CT
(GEM or VNR)
1ep: OS
2eps: PFS, RR,
toxicity, economic evaluation
Erlotinib