Epidermal growth factor receptor-mutated non-small-cell lung cancer: A primer on contemporary management

Rajendra, Akhil; Noronha, Vanita; Joshi, Amit; Patil, Vijay; Menon, Nandini; Prabhash, Kumar

doi:10.4103/crst.crst_51_19

Cited by 43 publications

(9 citation statements)

References 122 publications

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“…Three other studies have explored the strategy of adding chemotherapy to TKI. NEJ009 and GAP brain added chemotherapy to gefitinib; FLAURA2 added chemotherapy to osimertinib. All 3 reported a PFS benefit.…”

Section: Discussionmentioning

confidence: 99%

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Gefitinib vs Gefitinib Plus Pemetrexed and Carboplatin Chemotherapy in EGFR-Variant Lung Cancer—Long-Term Results of a Randomized Clinical Trial

Noronha,

Patil,

Menon

et al. 2024

JAMA Oncol

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Section: Discussionmentioning

confidence: 99%

“…All 3 reported a PFS benefit. OS improvement was reported in the initial NEJ009 article, GAP, and our study. FLAURA2 results are immature for OS interpretation.…”

Section: Discussionmentioning

confidence: 99%

Gefitinib vs Gefitinib Plus Pemetrexed and Carboplatin Chemotherapy in EGFR-Variant Lung Cancer—Long-Term Results of a Randomized Clinical Trial

Noronha,

Patil,

Menon

et al. 2024

JAMA Oncol

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“…Osimertinib is the treatment of choice for NSCLC with EGFR sensitizing mutations as well as T790M resistant mutations [32,33]. But due to its high cost, most patients in developing countries like India are unable to receive osimertinib, particularly at the approved dose of 80 mg orally daily [34].…”

Section: Discussionmentioning

confidence: 99%

Reduced frequency dosing of osimertinib in EGFR-mutant non-small cell lung carcinoma: Real world data

Noronha,

Sahu,

Kapoor

et al. 2023

Preprint

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Introduction Osimertinib has better efficacy than first generation EGFR-directed TKIs with similar safety profile. However, osimertinib is not affordable for most in developing nations. Moreover, minimum biologically effective dose of osimertinib may be less than approved, given uncertainty surrounding dose determination strategy for targeted agents Materials and Methods This was retrospective observational multicentric study aimed to describe the objective response rate(ORR), disease control rate(DCR), progression free survival(PFS), overall survival(OS), and toxicity of osimertinib 80 mg orally administered less frequently than daily (ranging from alternate day to once weekly) in patients with EGFR-mutated non-small cell lung cancer. Results Between January 2021 and August 2023, we enrolled 22patients. Six received osimertinib 80mg once weekly, nine received 80mg every three days, and seven received 80mg alternate days. Responses included 0 complete responses, 7(31.8%) partial responses, 9(40.9%) stable diseases, and 5(22.7%) progressive disease. ORR was 31.8%, and DCR was 72.7%. Median PFS was 9.2months (95% confidence interval[CI] 2.9–15.7), and median OS was 17.8months (95%CI, 3.2–32.6). In patients who received reduced frequency osimertinib in the second line and beyond, the ORR was 29.4%, DCR was 70.5%, median PFS was 5.9months (95%CI, 1.1–10.6) and median OS was 17.6months (95%CI, 2.9–32.2). Grade- 3 and higher toxicities were noted in 8(36.3%) patients. Conclusion Less frequent dosing of osimertinib may be valid treatment option especially in second line and beyond in patients who cannot afford full dose osimertinib. This may provide additional treatment option with similar toxicity profile as standard dose osimertinib.

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“…Until the 2000s, the standard-of-care treatment for patients with advanced NSCLC was platinum-based doublet chemotherapy for patients with a good PS, and BSC for patients with a poor PS. 30 Studies have shown that the use of cisplatin–gemcitabine, cisplatin–paclitaxel, carboplatin–paclitaxel and cisplatin–docetaxel resulted in similar response rates and survival in patients with advanced NSCLC. 31 In fact, survival outcomes were rather unsatisfactory with an overall response rate of 19% and median overall survival (OS) of 7.9 months (95% CI 7.3 to 8.5).…”

Section: Comparison Of Treatment Outcomes After Treatment With ...mentioning

confidence: 99%

Differential clinicopathological features, treatments and outcomes in patients with Exon 19 deletion and Exon 21 L858R EGFR mutation-positive adenocarcinoma non-small-cell lung cancer

et al. 2023

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The most common oncogenic driver in non-small-cell lung cancer (NSCLC) is the epidermal growth factor receptor (EGFR) gene mutations that occur more frequently among Asians (30%–50%) as opposed to Caucasians (10%–15%). Lung cancer is one of the most prevalent cancers in India, with a reported adenocarcinoma positivity ranging between 26.1% and 86.9% in NSCLC patients. The prevalence ofEGFRmutations in adenocarcinoma patients (36.9%) in India is higher than that of Caucasian patients and lower than that of East Asian patients. The exon 19 deletion (Ex19del) is more common than exon 21 L858R mutations in Indian patients with NSCLC. Studies have shown that the clinical behaviour of patients with advanced NSCLC differs betweenEGFREx19del and exon 21 L858R mutation status. In this study, we investigated the differences in clinicopathological features and survival outcomes after first line and second-line treatment withEGFRtyrosine kinase inhibitors (EGFRTKIs) in NSCLC patients with Ex19del and exon 21 L858REGFRmutation status. This study also focuses on the role and potential benefits of dacomitinib, a second-generation irreversibleEGFRTKI, in patients with Ex19del and exon 21 L858REGFRmutation-positive advanced NSCLC in Indian settings.

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Epidermal growth factor receptor-mutated non-small-cell lung cancer: A primer on contemporary management

Cited by 43 publications

References 122 publications

Gefitinib vs Gefitinib Plus Pemetrexed and Carboplatin Chemotherapy in EGFR-Variant Lung Cancer—Long-Term Results of a Randomized Clinical Trial

Gefitinib vs Gefitinib Plus Pemetrexed and Carboplatin Chemotherapy in EGFR-Variant Lung Cancer—Long-Term Results of a Randomized Clinical Trial

Reduced frequency dosing of osimertinib in EGFR-mutant non-small cell lung carcinoma: Real world data

Differential clinicopathological features, treatments and outcomes in patients with Exon 19 deletion and Exon 21 L858R EGFR mutation-positive adenocarcinoma non-small-cell lung cancer

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