EGFR tyrosine kinase inhibitors in the first-line or second-line treatment of patients with EGFR gene activating mutation

Abstract

Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) are a new group of agents for non-small-cel lung cancer patients. Identification of the predictive value of activating EGFR gene mutations allowed selection of patients likely to achieve true clinical benefit. TKI-EGFR may produce objective responses in more than 60% of patients and prolong progression-free survival to 10 months in mutation-positive patients. No improvement of overall survival was shown in randomized trials. Similar benefits were observed in patients within second-line treatment. No data are available for superiority of TKI-chemotherapy sequence over the reverse use of chemotherapy and TKI. It is suggested, that TKI-EGFR should be first-line treatment for mutation-positive patients, because of PFS and ORR benefit, better tolerance of treatment and quality of life improvement. According to current guidelines, mutation-positive patients should receive TKI-EGFR with a probability of overall survival in a range of 20 months in majority of patients. We aimed to review the literature on the use of TKI-EGFR as first-line and second-line treatment for mutation-positive non-small-cell lung cancer patients.