Interview with Prof Thomas J. Lynch, MD
Director of Yale Cancer Center,
New Haven, USA
Q. What is your takeaway message from the LUX-Lung 3 trial?
A. LUX-Lung 3 is an incredibly important study. It's a study which looked at patients who have EGFR mutations. These are activating mutations within the lung cancer cells that cause the cells to become cancerous. They also are mutations which give us a target to go after with drugs to try to improve outcome for patients. And what we learn is that inhibitors of the tyrosine kinase of EGFR can be very effective in treating lung cancer. In LUX-Lung 3 we see a comparison, a randomised trial comparison, between afatinib* and the best chemotherapy that's out there in lung cancer which is cisplatinum and pemetrexed. And in this comparison, what we found is that the progression-free survival was longer for those patients who had the tyrosine kinase inhibitor afatinib* than it was for the patients who had chemotherapy. More importantly, there appeared to be quality of life benefits for patients. Not only did they go longer before they had to switch treatments or their tumour was found to be growing but they had better shortness of breath and better quality of life; so was able to help patients overall.
Q. What can you tell us about the LUX-Lung 3 results for a non-Asian population?
A. Approximately, seventy percent of the patients who are in LUX-Lung 3 were of Asian background. They were enrolled around the world but about seventy percent were people of Asian, East Asian, background. And we know that patients who are East Asian have a higher chance of having an EGFR mutation, but, in my opinion, we're not really looking at geography, we're looking at biology. Whether you're a patient in Spain, a patient in Finland, a patient in Germany or a patient in New Haven, Connecticut, if you have an EGFR mutation, I believe that tyrosine kinase inhibitors, like afatinib*, like erlotinib, like gefitinib can be helpful.
Q. What is your opinion on the general quality of the LUX-Lung 3 trial?
A. So LUX-Lung 3 was done in a very high quality fashion. It used a prospective randomisation where the sub-groups were identified beforehand, before the trial actually began. I think it answers the question of whether or not the drug afatinib* is comparable to chemotherapy in treating patients with EGFR mutations and I think it showed that afatinib* is a better choice upfront than chemotherapy in treating patients. What we don't know is where does afatinib* sit compared to erlotinib or compared to gefitinib and the good news is that there are trials that are underway that will answer those specific questions.
*Afatinib is an investigational compound. Its safety and efficacy have not yet been fully established.