When to Consider Retreatment With Chemotherapy After FLAURA2 for EGFR-Mutant NSCLC
Panelists discuss how retreatment with platinum doublet chemotherapy after FLAURA2 progression is considered as a potential option when patients have been chemotherapy-free for at least 6 months (using platinum sensitivity principles), with clinicians preferring to exhaust all targeted therapies and considering newer agents like trastuzumab deruxtecan first, while acknowledging that retreatment with chemotherapy represents a safety net option for patients who remain fit enough to tolerate it.
EP: 1.The Evolution of EGFR-Mutated Advanced NSCLC Treatment: Present Considerations and Future Treatment Options
EP: 2.Has Combination Therapy Become the New Frontline Treatment Standard for EGFR-Mutant Metastatic NSCLC?
EP: 3.Decision Points to Consider When Choosing Treatment With Monotherapy or Combination Therapy for EGFR-Mutant mNSCLC
EP: 4.Evaluating Patient Preferences for the Treatment of EGFR-Mutant mNSCLC
EP: 5.Comparing the Combination Therapies for the Treatment of EGFR-Mutant mNSCLC
EP: 6.Considering Resistance Mechanisms When Choosing Therapy in the Frontline Setting
EP: 7.The Importance of Maintaining Quality of Life and Intervening Early When Adverse Events Occur in the Frontline Treatment Setting
EP: 8.Weighing the 1-Year Projected Overall Survival Benefit With MARIPOSA in the Frontline Treatment of EGFR-Mutant mNSCLC
EP: 9.Discussing the Time and Financial Toxicities Associated With Combination Therapies and Potential Mitigation Strategies
EP: 10.Discussing Potential Combination Therapy Medication-Associated Toxicities With Patients
EP: 11.Evaluating the Clinical Utility of Subcutaneous Amivantamab in the Treatment of EGFR-Mutant mNSCLC
EP: 12.The Importance of Multidisciplinary Collaboration With Subspecialty Physicians in the Toxicity Management With Treatment
EP: 13.Exploring Second-Line Treatment Options Including Targeted Radiation and Surgery for the Management of EGFR-Mutant mNSCLC
EP: 14.Tissue vs Plasma Biopsy After First Disease Progression in EGFR-Mutant NSCLC
EP: 15.Deciding Between a Biomarker-Directed Approach and a Biomarker-Agnostic Approach for Second-Line Treatment of EGFR-Mutant NSCLC
EP: 16.Continuing the Targeted TKI in the Second Line for the Treatment of EGFR-Mutant NSCLC
EP: 17.When to Consider Retreatment With Chemotherapy After FLAURA2 for EGFR-Mutant NSCLC
EP: 18.Patient Case Presentation: A 45-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Liver Metastases
EP: 19.Patient Case Presentation: A 69-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Symptomatic Brain Metastases
This segment explores the role of retreatment with platinum doublet chemotherapy for patients with EGFR-mutant metastatic non–small cell lung cancer (NSCLC) who have previously received chemotherapy as part of frontline or second-line therapy. The discussion addresses whether carboplatin-based combinations can be effectively reintroduced after disease progression, particularly following FLAURA-2 regimen use. The panel acknowledges this as a complex clinical scenario requiring careful consideration of prior treatment responses, treatment-free intervals, and available alternative options.
The clinical approach to chemotherapy retreatment draws on established principles of platinum sensitivity, with clinicians considering a 6-month treatment-free interval as a potential threshold for rechallenge, borrowing concepts from small cell lung cancer management. When contemplating retreatment, combinations such as carboplatin with taxane and bevacizumab are preferred options, particularly for patients who have been chemotherapy-free for extended periods and can tolerate additional cytotoxic therapy. However, the availability of trastuzumab deruxtecan for EGFR-mutant disease has shifted treatment preferences, with many clinicians favoring this targeted option over chemotherapy retreatment due to its demonstrated efficacy in EGFR-mutant populations and central nervous system penetration capabilities.
The practical implementation of chemotherapy retreatment remains limited, with clinicians viewing it as a “safety blanket” option reserved for patients who remain performance status-appropriate after exhausting targeted therapy options. The clinical scenarios requiring such retreatment are considered relatively uncommon, as patients must meet specific criteria including adequate performance status, sufficient treatment-free interval, and exhaustion of other therapeutic options. The panel expresses optimism that continued development of targeted therapies will reduce the need for chemotherapy retreatment over time. Clinical trial participation is consistently prioritized before considering chemotherapy rechallenge, reflecting the rapidly evolving treatment landscape and the preference for novel therapeutic approaches over returning to previously used cytotoxic regimens.
