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🌱 來自: Targeted therapy-of-NSCLC

EGFR TKI-as-Targeted therapy-of-NSCLC

• EGFR classical sensitizing mt (exon 19 deletion or L858R):
• Initial tx:
  • osimertinib (ORR 80%, PFS 18.9 mos)
    • (NEJM 2018;378:113)
    • Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer
  • erlotinib & Bev (ORR 59%, PFS 10.1 mos).
  • Prior care standards:
    • Erlotinib, gefitinib, afatinib, dacomitinib ↑ PFS, improved RR/PFS compared to plat doublet in 1st line (IPASS, NEJM 2010;362:2380).
  • S/e:
    • Rash (30-50% pts, Tx: Moisturizers, abx, topical steroids),
    • diarrhea
• Subsequent tx for EGFR T790M+ (50% resistance cases):
• Osimertinib
  • (if treated w/ erlotinib, gefitinib, afatinib, or dacomitinib) (NEJM 2015;372:1689) or progressive CNS dz, chemo if T790M-or continuation of TKI ± local Rx for progression (JCO 2013;31:3335)
• Adj. tx after tumor resection:
  • Osimertinib
• EGFR uncommon/atypical mt (S768O, L861Q, G719X):
  • Afatinib, osimertinib
• EGFR exon 20 insertion mt
  • 2L+ amivantamab, EGFR-MET bispecific (ORR 40%, PFS 8.3 mo) (JCO 2021;39(30):3391) or 2L+ mobocertinib, EGFR TKI (ORR 28%, PFS 7.3 mos) (Cancer Discov 2021;11(7):1688)