Tagrisso for Non-Small Cell Lung Cancer
- The targeted therapy Tagrisso (osimertinib) may reduce the risk of death by half for patients with non-small cell lung cancer that can be removed with surgery and has the EGFR mutation.
- The data from the ADAURA study is being presented at the 2023 ASCO Annual Meeting, the largest cancer conference.
- 88% of the patients who received the medication lived for five years or longer, while only 78% of those who received standard treatments.
- Despite successful surgery, lung cancer tends to return. Thus, there exists a significant need to improve outcomes for early-stage patients.
- These findings are a game changer, showing that the drug can indeed help these patients live longer with an improved quality of life.
- NSCLC patients should ask their doctor about being tested for the EGFR mutation and whether Tagrisso is an appropriate treatment option for them.
Osimertinib (trade name Tagrisso) showed an overwhelming improvement in the treatment outcomes for early-stage NSCLC patients with EGFR mutations who had their tumors removed, reducing their risk of death by 51%, the new study says.
Read MoreHe added: “We want our patients to live longer. … We added in this new drug, osimertinib, a pill that targets the epidermal growth receptor. What we found was that the patients that received osimertinib lived longer.”
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Indeed, 88% of the patients who received the medication were alive after five years, compared to only 78% of those receiving standard treatments.
Tagrisso is already approved for early-stage NSCLC with EGFR mutations, but doctors were still working to understand how exactly is was helping patients. This new data shows that Tagrisso can in fact help extend and improve lives – the ultimate goal.
This shows that NSCLC patients should get tested to see if they have the EGFR mutation, which can help doctors determine more appropriate treatment options.
If they do have the mutation, they should talk to their doctor about receiving Tagrisso and if that is an option that makes sense for them.
The ADAURA phase III trial is being presented at the 2023 American Society of Clinical Oncology's (ASCO) Annual Meeting, the largest cancer conference in the world.
Lung Cancer: The Leading Cause Of Cancer-Related Deaths In The US
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Lung cancer is one of the most deadly cancers in the United States. Around 238,340 new cases of lung cancer will be diagnosed in 2023. Around 127,070 patients will die from this disease in the same year, making it the leading cause of cancer-related death in the US.
Lung cancer is split into non-small cell lung cancer (NSCLC) and small-cell lung cancer, with 80-85% of the cases being NSCLCs.
Most cases of lung cancer are diagnosed after the cancer has advanced or spread outside the lungs and is not curable (late-stage or metastatic, respectively). Often, patients with such cancers are ineligible for surgeries, traditional chemotherapies, and/or radiation, leaving them with few, lackluster treatment options.
On the other hand, only 26% of lung cancer cases are diagnosed at an early stage when they are potentially curable and eligible for surgery, and the five-year survival rate is more than 60%.
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Early-Stage Lung Cancers Can Potentially Be Cured With Surgery
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Most but not all early-stage NSCLCs can be surgically removed. This can be followed by chemotherapy as indicated.
Only 21% of all early-stage NSCLC cases end up undergoing surgical removal. This number may be so low because surgery can be a taxing treatment for the body.
Common lung cancer surgery options include:
- Wedge resection, if the tumor is small and located on the outside of the lung. A piece of the lung (in the shape of a wedge) is removed and lung function is not affected.
- Lobectomy, or segmentectomy, involves the removal of a certain segment of the lung (a lobe).
Patients need to be in good health, have sufficient lung function, be able to retain sufficient lung tissue for normal function after surgery, and have a tumor that can be resected without damaging vital organs or major blood vessels.
Despite successful surgery, lung cancer tends to return, and the five-year survival for it stands at only 65%. Thus, there exists a significant need to improve the outcomes for early-stage patients.
Recent studies looking to do so have investigated tapping into lung cancer's specific genetic and molecular characteristics, such as EGFR.
EGFR Mutations In Lung Cancers; Potential Targets For Cutting-Edge Treatments
Epidermal growth factor receptor (EGFR) mutations are changes in the EGFR gene, which makes the EGFR protein. This protein is imperative to regulate the normal growth and proliferation of cells.
Changes in the gene and its protein can, therefore, lead to abnormal, unchecked cellular growth that can turn into cancers.
This is exactly what happens in EGFR-mutated (EGFRm) lung cancers. EGFR-mutated lung cancers make up 10-15% of cases, according to the American Lung Association.
For EGFRm NSCLC, the mutations can be targeted with highly specific drugs, such as Tagrisso. This medication has already shown great promise in patients with advanced-stage lung cancers. Now, it’s proving to improve outcomes for early-stage lung cancer patients as well.
"I've been working in lung cancer for 30 years. I never cured anyone with an EGFR inhibitor; the disease always recurred at some point. But I believe we are curing the cancer by using these best drugs early,” Herbst told Stat News outlet.
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How Does Tagrisso Work In Lung Cancer?
Tagrisso belongs to a class of drugs called tyrosine kinase inhibitors (TKIs). It binds to the mutated EGFR protein on the surface of cancer cells.
This prevents the protein from being activated.
The molecular signals that lead to uncontrolled proliferation are blocked and this ultimately inhibits cancer growth and survival.
Clinical Trial Seeks To Secure Tagrisso's Place in Early-Stage Lung Cancer Treatment
Researchers recruited 682 patients with early-stage (stage IB-IIIA) lung cancers with EGFR mutations. All patients underwent curative surgical treatments followed by chemotherapy, if appropriate.
They were then split into two groups:
- 339 patients who received Tagrisso, with or without chemotherapy
- 343 patients who received a placebo drug, with or without chemotherapy
In the data presented at the ASCO conference, the researchers reported that the risk of death was reduced by 51% compared to the placebo arm.
In measuring overall survival (OS), or the time a patient is alive after their initial diagnosis, the five-year OS for those who received Tagrisso was 88%, while it was 78% for those who received the placebo.
Susan Galbraith, the executive vice president of Oncology R&D at AstraZeneca, which manufactures Tagrisso, said this data is “further establishing this transformative medicine as the backbone treatment for EGFR-mutated lung cancer.”
“These results emphasize the importance of diagnosing patients with lung cancer early, testing for EGFR mutations and treating all those with an EGFR mutation with TAGRISSO,” she said in a press release.
Side Effects Of Tagrisso
Considering the results of this trial, Tagrisso is poised to become a staple in the treatment of NSCLC patients with EGFR mutations. However, this medication, like any other medication, comes with side effects, which should be carefully considered before prescribing it to patients.
Some of the more common side effects include:
- Cough
- Difficulty breathing
- Dizziness
- Lightheadedness
- Vision changes
- Chest pain
- Groin pain
- Leg pain
- Headaches
- Speech slurring
- Weakness or numbness of the arms and legs
- Blood count abnormalities, such as a low red and white blood cell count
Some less common side effects include:
- Fever
- Chills
- Loss of speech
- Severe weakness of one side of the body
- Temporary blindness
- Diarrhea
- Skin rashes and lesions
Rare but serious and life-threatening side effects can also occur, such as:
- Serious lung problems
- Heart problems, such as a decrease in heart function
- Severe allergic reactions requiring hospitalization
Patients who experience any of the side effects should immediately alert their physician.
Tagrisso: A Tremendous Step Forward In Early-Stage Lung Cancer Treatment
Improving the survival of lung cancer patients has been a significant challenge for physicians and researchers. Despite currently used curative treatments, such as surgical removal, the cancers tend to come back months to years after their initial diagnosis and treatment.
In this challenging treatment landscape, Tagrisso has emerged as a game-changer.
These results are monumental improvements in the treatment of NSCLC with EGFR mutations, especially since historical and current treatments for these patients have been lacking.
Next Steps for Patients
If you have been diagnosed with NSCLC that can be removed with surgery, it may be beneficial to speak to your doctor about whether Tagrisso makes sense for you.
Here are some questions you may consider asking your doctor to help understand your options?
- What stage is my NSCLC?
- Do I have an EGFR mutation? Can I be tested?
- Am I eligible to receive Tagrisso?
- How would you expect Tagrisso to help me?
- How long would you expect me to be on Tagrisso?
- How is Tagrisso different from chemotherapy?
- What side effects would you expect me to experience being on Tagrisso?
- Are there ways to manage those side effects?
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