What are first-line options for treatment of stage IV non–small cell lung cancer (NSCLC) in patients with a sensitizing endothelial growth factor receptor (EGFR) mutation?

Updated: Jul 15, 2021
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

First-line therapy:

  • In patients with T790M, L858R, or exon 19 deletion mutations, osimertinib should be offered.If osimertinib is not available, gefitinib with chemotherapy or dacomitinib may be offered.
  • Other options that may be offered include afatinib, erlotinib/bevacizumab, erlotinib/ramucirumab, gefitinib, erlotinib, or icotinib
  • In patients with a PS of 3, an EGFR tyrosine kinase inhibitor (TKI) may be offered.
  • In patients with  EGFR mutations other than exon 20 insertion mutations, T790M, L858R, or exon 19 deletion alterations, afatinib may be offered.
  • In patients with EGFR exon 20 insertion mutation causing resistance to first- and second-generation EGFR TKIs, doublet chemotherapy with or without bevacizumab or standard treatment for stage IV NSCLC without driver mutations may be offered.

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