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Roundtable Discussion at ESMO on Immunology in Cancer

Part1: ASPIRATION study versus IMPRESS study - What are the implications for clinical practice?

In this video, the panel discuss new data from ESMO on the combination of chemotherapy with TKI treatment beyond progression. Tony Mok (Chinese University of Hong Kong), lead author of IMRESS, talks about the implications of the study with the other panelists; Mary O’Brien (Royal Marsden Hospital, Sutton, Surrey, UK), Paul Baas (Netherlands Cancer Institute, Amsterdam) and Wilfried Eberhardt (University Hospital, Essen, Germany).

What do you suggest when a patient with an EGFR-positive cancer progresses on treatment with a tyrosine kinase inhibitor (TKI)? Two studies presented at ESMO 2014 set out to address the question in non-small cell lung cancer (NSCLC). The answer is not straightforward.

The ASPIRATION study included 207 patients with stage IV EGFR+ NSCLC treated with erlotinib. At progression (defined by RECIST), the treatment was either stopped or continued at the physician’s discretion. ASPIRATION found that patients who continued with erlotinib had a progression-free survival of 3.7 months longer than those who stopped on progression.

The results from IMPRESS, however, appear to contradict these findings. Patients whose lung cancer had developed resistance to gefitinib were given chemotherapy plus either gefitinib or placebo. The researchers had hoped that, since some tumour cells remain sensitive, continuing with the TKI inhibitor would improve progression-free survival. The results proved otherwise. Dr Mok gives his opinion on what these two sets of results mean for clinical practice.

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