Patients with metastatic NSCLC with an EGFR mutation are treated with targeted therapy. A comparative analysis of first-line treatments with erlotinib, gefitinib, and afatinib showed that survival was worse in men, older patients, and those with poorer performance status or extensive metastases. In patients with brain metastases, outcomes with gefitinib were less favorable than with erlotinib.
The follow-up study, of Rolof Gijtenbeek, with the newest agent, osimertinib, showed that patients with an Ex19del mutation had better survival than those with an L858R mutation. However, in the first-line setting, osimertinib did not provide a clear survival benefit over earlier-generation EGFR inhibitors, except in Ex19del patients with brain metastases.
Next, the potential benefit of adding chemotherapy to targeted therapy was investigated. While this combination improved progression-free survival, it had no impact on long-term survival and led to a significant increase in treatment-related toxicity.
An evaluation of long-term survivors (>3 years) showed that EGFR inhibitors were generally well tolerated, and patients were satisfied with their treatment. However, brain and bone metastases were the most significant health concerns.
Finally, a systematic review highlighted the importance of platinum-based doublet chemotherapy for NSCLC patients without an EGFR mutation, with a performance status of 2. Single-agent immunotherapy may be beneficial, but dual immunotherapy is not recommended.
