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Management of NSCLC Disease Progression After First-Line EGFR Tyrosine Kinase Inhibitors: What Are the Issues and Potential Therapies?

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Abstract

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) represent the standard of care for advanced non-small cell lung cancer (NSCLC) patients whose tumor harbors an activating EGFR mutation. The vast majority of patients will experience disease control with an EGFR-TKI but inevitably all patients will progress, often within a year of treatment. There is no current standard of care for this scenario but, in clinical practice, most of the patients will be offered platinum-based doublet chemotherapy. In some situations, continuation of the EGFR-TKI beyond radiological progression, with or without use of local treatments in case of oligo-progressive disease, represents a reasonable therapeutic option. The aim of this review is to describe the different treatment strategies that have been developed to tackle progression on EGFR-TKIs, including specific clinical scenarios and novel agents designed to tackle the common T790M resistance mutation.

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Authors and Affiliations

  1. Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK

    Raffaele Califano & Fiona Blackhall

  2. Department of Medical Oncology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK

    Raffaele Califano

  3. Medical Oncology Unit, Papageorgiou General Hospital, Thessaloniki, Greece

    Ourania Romanidou

  4. Department of Medical Oncology, University of Athens School of Medicine, Athens, Greece

    Giannis Mountzios

  5. Istituto Toscano Tumori, Ospedale Civile di Livorno,, Leghorn, Italy

    Lorenza Landi & Federico Cappuzzo

  6. University of Manchester, Manchester, UK

    Fiona Blackhall

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Correspondence to Raffaele Califano.

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R Califano: Consulting fees and honoraria from Roche, Astrazeneca, Lilly Oncology and Boehringer Ingelheim; Support to travel to meetings from Roche, Astrazeneca, Lilly Oncology and Boehringer Ingelheim. Payment for lectures from Roche, Astrazeneca, Lilly Oncology and Boehringer Ingelheim.

F Blackhall: Consulting fees and honoraria from Roche, Astrazeneca, Lilly Oncology and Boehringer Ingelheim; Support to travel to meetings from Roche, Astrazeneca, Lilly Oncology and Boehringer Ingelheim.

G Mountzios: consulting fees from Boehringer Ingelheim.

R Romanidou, F Cappuzzo and L Landi declare no relevant conflicts of interest.

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Califano, R., Romanidou, O., Mountzios, G. et al. Management of NSCLC Disease Progression After First-Line EGFR Tyrosine Kinase Inhibitors: What Are the Issues and Potential Therapies?. Drugs 76, 831–840 (2016). https://doi.org/10.1007/s40265-016-0578-z

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