Is there a role for VeriStrat testing in determining when to use an EGFR TKI in previously treated squamous cell NSCLC?

Although PD-1 inhibitors are now standard of care for second-line therapy of advanced NSCLC, there remains the question of which therapy is best to use after failure of nivolumab or pembrolizumab. LUX-Lung 8 (http://www.ncbi.nlm.nih.gov/pubmed/26156651) recently demonstrated a survival advantage for afatinib over erlotinib in previously treated advanced squamous-cell NSCLC. Would the results of VeriStrat testing influence you to choose an EGFR TKI over chemotherapy in this setting?

1 Answer

Mednet MemberInvited Expert

Medical Oncology · Johns Hopkins University/Sidney Kimmel Cancer Center

Answered on

Excellent question and one that we have very little data to answer. Extrapolating from the second line PROSE trial (http://www.ncbi.nlm.nih.gov/pubmed/24831979), it seems reasonable to consider this test to help choose between TKI vs. chemotherapy as a third line option. That said, there are certain nuances to consider (the PROSE trial was second line and evaluated erlotinib) and the question posed is about afatinib. In addition, it is up for debate whether TKIs should be considered at all in patients who don't harbor sensitizing EGFR mutations. For me, if I had a patient who had progressed on Nivolumab and still had a reasonable performance status, I would not use this test and go with docetaxel/ramucirumab if eligible given the need for r...

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