AstraZeneca's Adrian Kilcoyne Sees Paradigm Shift in Lung Cancer Treatment

Adrian Kilcoyne MD MBA MPH, vice president, US Medical Affairs and HEOR, oncology, AstraZeneca, discusses a paradigm shift in lung cancer treatment due to the overwhelming efficacy of the EGFR-TKI treatment.

MHE: After the news that ADAURA would be unblinded due to the overwhelmingly efficacy of the EGFR-TKI treatment, there has been a lot of excitement. Can we expect the results to be paradigm shifting?

Kilcoyne: I think absolutely. As you're aware, we've had some great results with Tagrisso (osimertinib) already in the metastatic setting. 

So, we have great promise about really bringing it earlier into the disease paradigm. And when we look at the ADAURA study, this is very much earlier into the potentially in longer-term curative setting, which is in the early stage stage IB up to IIIA; these are the resectable populations. So, what we've been able to demonstrate is compelling. I mean, any study that is stopped two years early has to be done for a very good reason. As you can imagine, this data is compelling in terms of the disease-free survival benefit we're seeing, but it's important in a number of ways. 

One, it's telling us that you hit [cancer] early, well, you can have very compelling results in lung cancer. The second is some of these patients, while they all had surgery, not all of them had adjuvant chemotherapy; so that half of the patients that chemotherapy, half didn't, and regardless of that you're seeing significant benefit. So, you're seeing in my view, there will be a paradigm shift-one, it may drive people to want to identify disease earlier, which is really important, too.

I think you'll see this is becoming standard of care in this area. Three, there's a whole question: do you also need to give chemotherapy? And again, we don't have enough data, we have to wait for referrals, [more] data etc. But I think those three areas or areas will see very significant changes in clinical care.

MHE: Osimertinib is already approved in the United States for the frontline setting in metastatic non-small cell lung cancer. What can we expect to see in the adjuvant setting after ASCO?

Kilcoyne: So after ASCO-and I think I’ve touched on some of the things already said-in the frontline metastatic setting, which is the late stage disease stage IV, we have seen great results with Tagrisso, really has become the standard of care for all intents and purposes. … At AstraZeneca we're very much committed to really eliminating cancer as a cause of death, and we do understand the best chance of achieving that is to treat early-identify the right patients early. This is what ADAURA is allowing us to do-treat patients early. Now if we think about the stage IBs are pretty early lung cancers, right through to stage III, that's a broad group of patients. But if you look at those groups individually, we're seeing benefits in each group. So, this is incredibly compelling for physicians now to be able to treat their very early lung cancers, which would probably have a good chance of cure just resection, but still a huge proportion of these patients will relapse. So this is for me going to be a huge change in clinical care.