It is not yet clear if it is beneficial to continue first-line EGFR tyrosine kinase inhibitors in patients with EGFR-mutated lung cancer who experience progression and are started on chemotherapy, according to Dr. Horn. Two trials, one in Asia (looking at gefitinib [Iressa]) and one in North America (looking at erlotinib [Tarceva]), will be evaluating outcomes with this practice.

“There has been compelling data published on the flare phenomenon in patients who are on a first-line EGFR [tyrosine kinase inhibitor] who stop therapy,” she noted. “Right now, there are no great data to say you should continue the EGFR [tyrosine kinase inhibitor] and add chemotherapy. What I tend to do is either tell the patients to stop the [tyrosine kinase inhibitor] the day they start chemotherapy, to sort of prevent that flare phenomenon, or I just let them finish out their bottle if they have got another 2 weeks’ supply, just let them continue on the [tyrosine kinase inhibitor] while you initiate chemotherapy.” ■