Anticipating EGFR Targeting in Early Stages of Lung Cancer: Leave No Stone Unturned

Abstract

Background: The current treatment landscape of early stage lung cancer is rapidly evolving, particularly in EGFR mutant non-small cell lung cancer (NSCLC), where target therapy is moving to early stages. In the current review, we collected the available data exploring the impact of EGFR targeting in both neoadjuvant and adjuvant settings, underlying lights and shadows and discussing the existing open issues. Methods: We performed a comprehensive search using PubMed and the proceedings of major international meetings to identify neoadjuvant/adjuvant trials with EGFR tyrosine kinase inhibitors (TKIs) in NSCLC. Results: Limited data are available so far about the activity/efficacy of neoadjuvant TKIs in EGFR mutant NSCLC, with only modest downstaging and pathological complete response rates reported. Differently, the ADAURA trial already proposed osimertinib as a potential new standard of care in resected NSCLC harboring an activating EGFR mutation. Conclusion: Anticipating targeted therapy to early stage EGFR mutant NSCLC presents great opportunities but also meaningful challenges in the current therapeutic/diagnostic pathway of lung cancer care. Appropriate endpoint(s) selection for clinical trials, disease progression management, patients’ and treatment selection, as well as need to address the feasibility of molecular profiling anticipation, represent crucial issues to face before innovation can move to early stages.

Pathological complete response in an advance stage IIIB non‐small cell lung cancer secondary to neoadjuvant osimertinib targeted therapy: A case report and review of literature

“…Recently, EGFR‐TKI‐NTT has also been explored because targeted therapy with EGFR‐TKIs results in better treatment outcomes and lower treatment‐related toxicity compared to platinum‐doublet chemotherapy in patients with metastatic NSCLC 3 . Although there is still a paucity of data on EGFR‐TKI‐NTT, some early reports supported its role 3–6 . In a case series of 13 patients, Hu et al has reported a 69.2% objective response rate, 100% complete resection rate and 100% pathologic downstaging rate with the use of osimertinib‐NTT 7 .…”