TY - JOUR
T1 - An Evolving Algorithm to Select and Sequence Therapies in EGFR Mutation-positive NSCLC
T2 - A Strategic Approach
AU - Melosky, Barbara
AU - Popat, Sanjay
AU - Gandara, David R
PY - 2017
Y1 - 2017
N2 - The optimal treatment sequence for patients with metastatic epidermal growth factor receptor (EGFR) mutation-positive (EGFR-M+) non-small-cell lung cancer (NSCLC) continues to evolve, related largely to an increasing number of breakthroughs and studies in the field. The efficacy of tyrosine kinase inhibitors in the treatment of these patients is well established; however, the treatment decision-making process is becoming more complex as our knowledge of EGFR mutations and resistance pathways grows and more treatment options become available. Thus, treating physicians must consider an increasing number of factors. We present a stepwise approach to personalizing the treatment of patients with EGFR-M+ NSCLC, emphasizing some of the real world challenges faced by treating physicians. We reviewed the decision criteria for selecting the best first-line therapy, highlighted the importance of repeat biopsy on disease progression to determine the most appropriate next-line therapy, and discussed the options for third-line therapy and beyond. We also present an algorithm designed to optimize the sequencing strategies for prolonging survival and maintaining quality of life in our patients with EGFR-M+ NSCLC.
AB - The optimal treatment sequence for patients with metastatic epidermal growth factor receptor (EGFR) mutation-positive (EGFR-M+) non-small-cell lung cancer (NSCLC) continues to evolve, related largely to an increasing number of breakthroughs and studies in the field. The efficacy of tyrosine kinase inhibitors in the treatment of these patients is well established; however, the treatment decision-making process is becoming more complex as our knowledge of EGFR mutations and resistance pathways grows and more treatment options become available. Thus, treating physicians must consider an increasing number of factors. We present a stepwise approach to personalizing the treatment of patients with EGFR-M+ NSCLC, emphasizing some of the real world challenges faced by treating physicians. We reviewed the decision criteria for selecting the best first-line therapy, highlighted the importance of repeat biopsy on disease progression to determine the most appropriate next-line therapy, and discussed the options for third-line therapy and beyond. We also present an algorithm designed to optimize the sequencing strategies for prolonging survival and maintaining quality of life in our patients with EGFR-M+ NSCLC.
KW - Afatinib
KW - Del19
KW - Gefitinib
KW - L858R
KW - T790M
UR - http://www.scopus.com/inward/record.url?scp=85021287970&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85021287970&partnerID=8YFLogxK
U2 - 10.1016/j.cllc.2017.05.019
DO - 10.1016/j.cllc.2017.05.019
M3 - Article
C2 - 28668205
AN - SCOPUS:85021287970
JO - Clinical Lung Cancer
JF - Clinical Lung Cancer
SN - 1525-7304
ER -