Treatment of advanced non-small-cell lung cancer with epidermal growth factor receptor (EGFR) mutation or ALK gene rearrangement: Results of an International expert panel meeting of the Italian association of thoracic oncology
Journal
Clinical Lung Cancer
Journal Volume
15
Journal Issue
3
Pages
173-181
Date Issued
2014
Author(s)
Gridelli C
De Marinis F
Cappuzzo F
Di Maio M
Hirsch F.R
Mok T
Morgillo F
Rosell R
Spigel D.R
Ciardiello F.
Abstract
The availability of targeted drugs has made the assessment of the EGFR mutation and ALK rearrangement critical in choosing the optimal treatment for patients with advanced non-small-cell lung cancer (NSCLC). In May 2013, the Italian Association of Thoracic Oncology (AIOT) organized an International Experts Panel Meeting to review strengths and limitations of the available evidence for the diagnosis and treatment of advanced NSCLC with EGFR or anaplastic lymphoma kinase (ALK) alterations and to discuss implications for clinical practice and future clinical research. All patients with advanced NSCLC, with the exclusion of pure squamous cell carcinoma in former or current smokers, should be tested for EGFR mutations and ALK rearrangements before decisions are made on first-line treatment. First-line treatment of EGFR-mutated cases should be with an EGFR tyrosine kinase inhibitor (TKI). Any available agent (gefitinib, erlotinib, or afatinib) can be used, until further data from comparative studies may better guide TKI selection. As general rule, and when clinically feasible, results of EGFR mutational status should be awaited before starting first-line treatment. Panelists agreed that the use of crizotinib is justified in any line of treatment. Although solid evidence supporting the continuation of EGFR TKIs or crizotinib beyond progression is lacking, in some cases (minimal, asymptomatic progression, or oligoprogression manageable by local therapy), treatment continuation beyond progression could be justified. Experimental strategies to target tumor heterogeneity and to treat patients after failure of EGFR TKIs or crizotinib are considered high-priority areas of research. A number of relevant research priorities were identified to optimize available treatment options. ?2014 Elsevier Inc. All rights reserved.
Subjects
ALK rearrangement; Epidermal growth factor receptor mutation; Non-small-cell lung cancer
SDGs
Other Subjects
afatinib; anaplastic lymphoma kinase; carboplatin; cisplatin; crizotinib; docetaxel; epidermal growth factor receptor; erlotinib; gefitinib; gemcitabine; navelbine; paclitaxel; pemetrexed; antineoplastic agent; epidermal growth factor receptor; protein kinase inhibitor; protein tyrosine kinase; advanced cancer; ALK gene; biopsy technique; cancer adjuvant therapy; cancer chemotherapy; cancer diagnosis; cancer patient; clinical practice; clinical research; comparative study; EGFR gene; gene; gene mutation; gene rearrangement; local therapy; lung non small cell cancer; medical decision making; progression free survival; research priority; review; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; disease course; gene rearrangement; genetics; human; Lung Neoplasms; molecularly targeted therapy; mutation; pathology; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Disease Progression; Gene Rearrangement; Humans; Lung Neoplasms; Molecular Targeted Therapy; Mutation; Protein Kinase Inhibitors; Receptor Protein-Tyrosine Kinases; Receptor, Epidermal Growth Factor
Publisher
Cancer Information Group, LP
Type
review