From the Guidelines
The best treatment for Epidermal Growth Factor Receptor (EGFR) mutant non-small cell lung cancer is first-line therapy with third-generation EGFR tyrosine kinase inhibitors (TKIs), such as osimertinib, due to its superior efficacy and better brain penetration compared to earlier generation TKIs. This recommendation is based on the most recent and highest quality study available, which suggests that osimertinib is the preferred option for patients with common EGFR mutations 1.
Key Points to Consider
- Osimertinib (80mg daily) is the preferred first-line treatment for patients with common EGFR mutations, including exon 19 deletions or p.L858R, due to its ability to specifically block the abnormal signaling from mutated EGFR receptors that drive cancer growth 1.
- Alternative first-line options, such as erlotinib (150mg daily), gefitinib (250mg daily), or afatinib (40mg daily), may be considered, but osimertinib is generally preferred due to its superior efficacy and better brain penetration 1.
- Common side effects of EGFR TKIs include skin rash, diarrhea, and fatigue, which can often be managed with supportive care.
- If resistance develops to first-line TKIs, molecular testing should be performed to identify resistance mechanisms, particularly the T790M mutation, which may respond to osimertinib if not used initially 1.
Comparison to Other Treatments
- Traditional chemotherapy is generally not recommended as first-line therapy for patients with EGFR mutant non-small cell lung cancer, as EGFR TKIs have been shown to have higher response rates (60-80%) and longer progression-free survival, while offering better quality of life due to fewer severe side effects 1.
- Other treatments, such as combination cytotoxic chemotherapy or crizotinib, may be considered in certain situations, but osimertinib remains the preferred first-line treatment for patients with common EGFR mutations 1.
From the FDA Drug Label
1.3 First-line Treatment of EGFR Mutation-Positive Metastatic NSCLC TAGRISSO is indicated for the first-line treatment of adult patients with metastatic NSCLC whose tumors have EGFR exon 19 deletions or exon 21 L858R mutations, as detected by an FDA-approved test 1.1 EGFR Mutation-Positive, Metastatic Non-Small Cell Lung Cancer GILOTRIF is indicated for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have non-resistant epidermal growth factor receptor (EGFR) mutations as detected by an FDA-approved test
The best treatment for Epidermal Growth Factor Receptor (EGFR) mutant non-small cell lung cancer is osimertinib (TAGRISSO) or afatinib (GILOTRIF), as they are both indicated for the first-line treatment of metastatic NSCLC with EGFR mutations, as detected by an FDA-approved test 2 3.
- Osimertinib (TAGRISSO) is indicated for patients with EGFR exon 19 deletions or exon 21 L858R mutations.
- Afatinib (GILOTRIF) is indicated for patients with non-resistant EGFR mutations.
From the Research
Treatment Options for EGFR Mutant Non-Small Cell Lung Cancer
- The standard first-line treatment for patients with advanced and recurrent EGFR-positive non-small cell lung cancer is EGFR-tyrosine kinase inhibitors 4, 5, 6, 7, 8.
- Osimertinib, a third-generation EGFR-TKI, has been shown to be effective in treating EGFR-mutant non-small cell lung cancer, particularly in patients with brain metastasis 4, 7.
- The clinical efficacy of osimertinib has been compared to other EGFR-TKIs, such as afatinib, gefitinib, and erlotinib, with osimertinib demonstrating improved progression-free survival and overall survival in some patient populations 4, 7, 8.
Patient Subgroups and Treatment Outcomes
- Patients with brain metastasis at baseline may benefit from osimertinib as first-line treatment, with improved median progression-free survival compared to afatinib 4.
- Patients with liver metastases may not benefit as much from osimertinib, with shorter progression-free survival and overall survival compared to patients without liver metastases 7.
- The effectiveness of osimertinib in patients with exon 19 deletion or L858R mutation has been demonstrated, with improved progression-free survival and overall survival compared to other EGFR-TKIs 7, 8.