How First-Line Treatment of EGFR-Mutated NSCLC Has Changed

Estelamari Rodriguez, MD, MPH, of Sylvester Comprehensive Cancer Center opens this CancerNetwork Around the Practice discussion on first-line therapy for epidermal growth factor receptor (EGFR)-mutated advanced non–small cell lung cancer (NSCLC) with panelists Matthew Gumbleton, MD, PhD, of Huntsman Cancer Institute, and Siddhartha Devarakonda, MD, of Providence Swedish Cancer Institute. Dr Devarakonda describes a field that has moved from single-agent tyrosine kinase inhibitor (TKI) therapy to 2 or 3 reasonable intensified options, and says the majority of his patients now receive a combination because of the overall survival benefit, although he does not consider single-agent TKI therapy obsolete for the right patient. He notes that roughly 30% of patients never reach second-line treatment. Dr Gumbleton says nearly every patient needs an intensified regimen up front, reserving single-agent therapy mainly for older patients with comorbidities or limited life expectancy, because clinicians cannot predict who will do well on a single agent and patients who progress are in a far tougher position.