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Expert Think Tank on <i>EGFR</i>m NSCLC: Module

CE / CME

Expert Think Tank: Lung Cancer Experts Discuss Current Standard of Care and Ongoing Challenges in the Care of Patients With EGFR-Mutated NSCLC

Pharmacists: 1.25 contact hours (0.125 CEUs)

Nurses: 1.25 Nursing contact hours

Physicians: Maximum of 1.25 AMA PRA Category 1 Credits™

Released: September 30, 2022

Expiration: September 29, 2023

Edward B Garon
Edward B Garon, MD, MS
Xiuning Le
Xiuning Le, MD, PhD
Zofia Piotrowska
Zofia Piotrowska, MD
Mark A. Socinski
Mark A. Socinski, MD
Helena Yu
Helena Yu, MD
CME/CE Information

Activity

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Course Completed

In this module, Edward B. Garon, MD, MS, leads a discussion with his colleagues—Xiuning Le, MD, PhD; Zofia Piotrowska, MD, MHS; Mark A. Socinski, MD; and Helena A. Yu, MD—about the findings from a survey asking oncology healthcare professionals (HCPs) about their current practice caring for patients with EGFR-mutated non-small-cell lung cancer (NSCLC), including current best practices for EGFR mutation testing, the latest clinical data informing the optimal treatment of EGFR-mutated NSCLC in the early-stage and advanced settings, and what’s on the horizon.

The survey was targeted to HCPs across the globe involved in the care of patients with lung cancer. Of the 77 HCPs who responded to all survey questions, the majority were physicians (78%) with the remainder being advanced practice providers (3%), nurses (8%), pharmacists (9%), and allied health professionals (2%). Of the participating HCPs, 71% saw 5 or more patients with lung cancer a month and 39% worked at an academic medical center, 37% in community practice, and 15% at a government medical facility, with the remaining 9% being in private or specialty practice. The responding HCPs practiced lung cancer care around the world: 30% in the United States, 28% in Asia, 17% in Europe, 15% in Latin America/Caribbean/South America, 5% in Africa, 3% in Canada, and 2% in the Middle East.

Please note that the key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. A few questions will be asked twice: once at the beginning of the activity and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

For those providing patient care, how many patients with NSCLC do you see in a typical month?

How confident are you in talking to your patients about the rationale behind combining an EGFR tyrosine kinase inhibitor (TKI) and VEGF(R) inhibitor in the treatment of EGFR-positive advanced NSCLC?

Please rate your confidence from 1-7 on the scale below.

A 55-year-old Asian woman without a smoking history presented to her primary care physician with cough and dyspnea on exertion. A chest x-ray image showed a right-sided pleural effusion. Thoracentesis was performed with 1 liter of fluid removed; subsequent cytology was consistent with adenocarcinoma with PD-L1 expression of 90%. A PET scan showed diffuse right-sided pleural involvement and osseous metastases and her brain MRI showed 2 small brain metastases. Molecular testing on the pleural effusion and plasma showed an EGFR L858R mutation and a TP53 P278S co-mutation.

According to current clinical data, which of the following would be the optimal first-line therapy for this patient with an EGFR L858R mutation, a high PD-L1 expression of 90%, and CNS involvement?

A 62-year-old man presented with progressive shortness of breath. A chest/abdomen/pelvis CT scan revealed a 3.5-cm left lower lobe mass, extensive left lung lymphangitic spread, and innumerable sub-cm nodules in both lungs. A biopsy of a peripheral lung lesion revealed lung adenocarcinoma, with PD-L1 expression of 35% on immunohistochemistry (IHC) and an EGFR exon 20 insertion mutation on tissue next-generation sequencing (NGS). A PET/CT scan was negative outside the chest and an MRI of the brain was normal. He received first-line pembrolizumab plus carboplatin/pemetrexed and now has progression of disease.

Based on available evidence of efficacy and safety, which of the following therapies would you recommend next for this patient?
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