Expert Point of View: John Heymach, MD


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John Heymach, MD

John Heymach, MD

"TO PUT THESE RESULTS into context, currently we have three approved epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors for EGFR-positive non–small cell lung cancer (NSCLC): gefitinib (Iressa), erlotinib (Tarceva), and afatinib (Gilotrif). Not many studies have compared these drugs head-to-head. From the perspective of doctors who treat lung cancer daily, the 5+-month difference in progression-free survival with dacomitinib vs gefitinib is a substantial advance,” said ASCO expert John Heymach, MD, Professor and Chairman of the Department of Thoracic/Head and Neck Medical Oncology at The University of Texas MD Anderson Cancer Center in Houston. “Dacomitinib is not just another EGFR tyrosine kinase inhibitor. This study puts it at the front of the pack.” 

Dr. Heymach agreed with Dr. Mok that dacomitinib does have substantial toxicity, as reflected by the need for dose reduction in 66% of patients. “But I would like to emphasize this is not life-threatening toxicity, and we are accustomed to managing this with patients,” Dr. Heymach noted. 

“Even though few patients require a dose reduction on gefitinib, the duration of response with dacomitinib is twice as long. It might be the dose of dacomitinib is too high or the dose of gefitinib is too low. Dacomitinib clearly requires close monitoring and careful surveillance by experienced care providers, whereas a drug like gefitinib does not,” Dr. Heymach continued. 

“If dacomitinib is approved by the U.S. Food and Drug Administration, this will require a discussion with patients about the trade-off between toxicity and efficacy,” he noted. ■

DISCLOSURE: Dr. Heymach has participated in scientific advisory boards for Novartis.



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