PMID- 35343193
OWN - NLM
STAT- MEDLINE
DCOM- 20220331
LR  - 20220401
IS  - 1998-4774 (Electronic)
IS  - 0019-509X (Linking)
VI  - 59
IP  - Supplement
DP  - 2022 Mar
TI  - Ideal sequencing in Stage IV epidermal growth factor receptor mutant 
      Non-Small-Cell Lung Cancer.
PG  - S80-S89
LID - 10.4103/ijc.IJC_50_21 [doi]
AB  - Evidence from several studies has shown improved progression-free survival (PFS) 
      with first- or second-generation epidermal growth factor receptor (EGFR)-tyrosine 
      kinase inhibitors (TKIs) compared with chemotherapy for advanced NSCLC patients. 
      But resistance to first or second-generation TKI therapies after 9 to 12 months 
      of treatment initiation is a concern. Osimertinib is a third-generation, 
      irreversible, oral EGFR-TKI that potently and selectively inhibits both EGFRm 
      (epidermal growth factor receptor mutated) and EGFR T790M and has demonstrated 
      efficacy in NSCLC central nervous system (CNS) metastases. Trials have reported 
      significantly longer PFS and higher median duration of response with osimertinib 
      compared with first-generation EGFR-TKIs (erlotinib, gefitinib) and chemotherapy, 
      respectively. And relatively lower rates of discontinuation due to adverse events 
      (AEs). Significant improvement in overall survival was also observed when used as 
      first-line treatment. Because EGFR-mutated tumors are highly dependent on EGFR 
      signaling, optimal sequence of available TKIs - erlotinib, gefitinib, afatinib, 
      dacomitinib, and osimertinib - is necessary. The sequencing of EGFR-TKIs has 
      changed over the past decade and depends on factors such as expected efficacy, 
      CNS activity, tolerability, and options available after progression. 
      Third-generation TKI may be the preferred first-line treatment because patients 
      may not opt for or die before the start of second-line therapy, and it is 
      difficult to predict which patients will eventually develop T790M mutation. The 
      favorable tolerability profile alongside a longer time to disease progression 
      makes osimertinib a preferred first-line treatment. Though clinical practice 
      guidelines do not provide clear consensus on the most preferred EGFR-TKI, recent 
      updates recommend osimertinib as a first-line treatment for advanced NSCLC 
      patients. Also, improved patient selection incorporating clinical and molecular 
      characteristics will help translate to better survival outcomes and improved 
      quality of life. This review aims to determine the optimal sequence of 
      administration of the EGFR-TKIs considering toxicity, quality of life, and 
      survival outcomes among advanced NSCLC patients.
FAU - Walia, Meenu
AU  - Walia M
AD  - Department of Medical Oncology, Max Super Specialty Hospital, Patparganj, New 
      Delhi, India.
FAU - Singhal, Manish K
AU  - Singhal MK
AD  - Department of Medical Oncology, Apollo Hospital, Sarita Vihar, New Delhi, India.
FAU - Kamle, Mangesh S
AU  - Kamle MS
AD  - Department of Oncology, AstraZeneca Pharma India Limited, India.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - India
TA  - Indian J Cancer
JT  - Indian journal of cancer
JID - 0112040
RN  - 0 (Protein Kinase Inhibitors)
RN  - EC 2.7.10.1 (ErbB Receptors)
SB  - IM
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy/genetics/pathology
MH  - ErbB Receptors/genetics
MH  - Humans
MH  - *Lung Neoplasms/drug therapy/genetics/pathology
MH  - Mutation
MH  - Protein Kinase Inhibitors/therapeutic use
MH  - Quality of Life
OTO - NOTNLM
OT  - Epithelial growth factor receptor mutations
OT  - T790M mutation
OT  - non-small-cell lung cancer
OT  - osimertinib
OT  - tyrosine kinase inhibitors
COIS- None
EDAT- 2022/03/29 06:00
MHDA- 2022/04/01 06:00
CRDT- 2022/03/28 07:09
PHST- 2022/03/28 07:09 [entrez]
PHST- 2022/03/29 06:00 [pubmed]
PHST- 2022/04/01 06:00 [medline]
AID - IndianJournalofCancer_2022_59_5_80_340526 [pii]
AID - 10.4103/ijc.IJC_50_21 [doi]
PST - ppublish
SO  - Indian J Cancer. 2022 Mar;59(Supplement):S80-S89. doi: 10.4103/ijc.IJC_50_21.