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Interpreting the Role of the Ramucirumab Plus Erlotinib Combination in EGFR+ NSCLC

Marina C. Garassino, MD
Published Online:6:30 PM, Tue June 18, 2019

Marina C. Garassino, MD, medical consultant, Thoracic Unit, Fondazione IRCCS – Istituto Nazionale dei Tumori, Milan, Italy, discusses the results from the randomized phase III RELAY trial, in which the combination of ramucirumab (Cyramza) plus erlotinib (Tarceva) was compared to erlotinib plus placebo in patients with EGFR-mutated non–small cell lung cancer (NSCLC). These data were presented at the 2019 ASCO Annual Meeting.

Overall, the median progression-free survival (PFS) was 19.4 months by investigator assessment in the ramucirumab/erlotinib arm versus 12.4 months in the erlotinib-alone arm (HR, 0.591; 95% CI, 0.461-0.760; P <.0001). Garassino says it is still early for the overall survival data as they have not yet matured, but the results suggest that the PFS2 is longer in the combination arm as well. She also notes that the toxicity profile was manageable with the combination regimen.

The next challenges with these data are incorporating the combination into clinical practice and deciding if osimertinib (Tagrisso) is still needed in the frontline for patients with EGFR-positive NSCLC. Oncologists debated the role of osimertinib at this year’s meeting, looking at 2 different clinical scenarios: patients could receive a well-tolerated oral drug or have to come into the clinic every 2 weeks to receive antiangiogenics intravenously. Garassino concludes that this comparison would be interesting to see in a head-to-head trial.
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