Overview of current systemic management of EGFR-mutant NSCLC
Journal
Annals of Oncology
Journal Volume
29
Pages
i3-i9
Date Issued
2018
Author(s)
Abstract
Front-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) therapy is the standard of care for lung cancer patients with sensitising EGFR mutations (exon 19 deletion or L858R mutation). Several phase III studies have demonstrated the superiority of gefitinib, erlotinib (first generation of TKIs) or afatinib (second generation) to chemotherapy in progression-free survival and response rates. Drug-related toxicities, such as diarrhoea, acneiform skin rash, mucositis, and paronychia, are frequently encountered in patients who receive EGFR TKIs. Other rare side-effects, such as hepatic impairment and interstitial lung disease, should be identified early and managed carefully. Patients with uncommon EGFR mutations, such as G719X, S768I, and L861Q, may require special selection of EGFR TKIs. The combination of erlotinib plus bevacizumab has been accepted in certain parts of the world as an alternative front-line treatment. This review article summarizes the studies leading to the establishment of EGFR TKIs in EGFR-mutant lung cancer patients. The side-effect profiles of the current EGFR TKIs in these large trials are listed, and the management of uncommon EGFR mutations is discussed. Finally, the potential role of combination front-line treatment is discussed. ? The Author(s) 2018. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Subjects
Afatinib; Epidermal growth factor receptor; Erlotinib; Gefitinib; Non-small cell lung cancer; Sensitising EGFR mutation
SDGs
Other Subjects
afatinib; bevacizumab; dacomitinib; epidermal growth factor receptor; epidermal growth factor receptor kinase inhibitor; erlotinib; gefitinib; pemetrexed; antineoplastic agent; bevacizumab; EGFR protein, human; epidermal growth factor receptor; erlotinib; protein kinase inhibitor; acne; age; cancer combination chemotherapy; cancer immunotherapy; cancer prognosis; cancer survival; cornea erosion; diarrhea; drug response; drug safety; drug treatment failure; EGFR gene; epistaxis; exon; functional status; gene deletion; gene mutation; human; interstitial lung disease; liver toxicity; meningeal metastasis; mucosa inflammation; mutant; non small cell lung cancer; paronychia; priority journal; rash; Review; stomatitis; systemic therapy; unspecified side effect; wild type; acne; adverse event; diarrhea; drug resistance; genetics; interstitial lung disease; lung tumor; molecularly targeted therapy; mortality; mucosa inflammation; non small cell lung cancer; paronychia; patient selection; procedures; randomized controlled trial (topic); toxic hepatitis; Acneiform Eruptions; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Carcinoma, Non-Small-Cell Lung; Chemical and Drug Induced Liver Injury; Diarrhea; Drug Resistance, Neoplasm; ErbB Receptors; Erlotinib Hydrochloride; Exons; Humans; Lung Diseases, Interstitial; Lung Neoplasms; Molecular Targeted Therapy; Mucositis; Paronychia; Patient Selection; Progression-Free Survival; Protein Kinase Inhibitors; Randomized Controlled Trials as Topic
Publisher
Oxford University Press
Type
Review