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International multicenter randomized phase III study of 1 st line erlotinib followed by 2 nd line cisplatin + gemcitabine vs. 1 st line cisplatin + gemcitabine followed by 2 nd line erlotinib in advanced NSCLC. The TORCH trial.

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  1. International multicenter randomized phase III study of 1st line erlotinib followed by 2nd line cisplatin + gemcitabine vs. 1st line cisplatin + gemcitabine followed by 2nd line erlotinib in advanced NSCLC. The TORCH trial Authors: C.Gridelli1, F.Ciardiello2, R.Feld3, C.Butts4, V.Gebbia5, G.Genestreti6, A.Favaretto7, R.Wierzbicki8, C.Gallo2, F. Perrone9 on behalf of the TORCH Investigators Reviewed by: Dr. Charles Butts Date posted: ASCO 2010 Updates – June 15, 2010

  2. Thank you for downloading this update. Please feel free to use it for educational purposes. Please acknowledge OncologyEducation.ca and Dr. Butts when using these slides.

  3. Treatment A: First line Cisplatin + gemcitabine Followed by second line erlotinib at progression R Treatment B: First line erlotinib followed by Cisplatin + Gemcitabine at progression NSCLC No prior chemo Stage IIIB/IV PS 0,1

  4. Baseline characteristics (1)

  5. Baseline characteristics (2)

  6. RESULTS

  7. STUDY COMMENTARY • This trial was designed prior to the IPASS results becoming available. • Patient population was similar to Canadian population with majority being male, 3% Asian, and 20% never smokers • In an unselected population of Western patients with advanced NSCLC, the standard approach with chemo first followed by erlotinib second is superior to the reverse. • First line erlotinib results in lower response rates, shorter PFS and shorter OS in this population. • Overall, severe toxicities were no different.

  8. BOTTOM LINE FOR CANADIAN MEDICAL ONCOLOGISTS • Platinum based doublet chemotherapy remains standard first line therapy for unselected patients with advanced NSCLC. • These results compliment and enforce the results of the IPASS trial. • Patients with advanced NSCLC should not receive first line RGFR TKI without EGFR mutation status being tested.

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