Frontline Treatment of Advanced NSCLC

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To select the most efficacious first-line treatment for each patient with non-small cell lung cancer (NSCLC) determination of mutation status is essential. While immunohistochemistry (IHC) and FISH can detect presence and amplification of EGFR, there is not a strong correlation between these measures and actual mutation status. Thus, to accurately test for EGFR mutation status, PCR-based testing is recommended.

According to Corey J. Langer, MD, a professor of Medicine, at the University of Pennsylvania, numerous prospective, randomized trials have demonstrated that for patients with EGFR-mutated NSCLC, a tyrosine-kinase inhibitor (TKI) is superior to chemotherapy. Improvements with TKIs were seen in response rate, disease control, symptom control, progression-free survival, and quality of life.

Currently, there are two FDA approved drugs for EGFR-mutated NSCLC, erlotinib and afatinib. Lecia V. Sequist, MD, MPH, an associate professor of Medicine at Harvard Medical School stresses that there are no head to head studies of the agents, as of yet. Subsequently, when making a treatment choice, it is necessary to look across the different studies were conducted with each drug and use these data to compare the two options.

As a results of this type of comparison across studies, it appears that afatinib is slightly more efficacious than erlotinib, but may result more toxicities. Thus, the final selection will require the balancing of efficacy and safety. However, for patients with EGFR exon 19 deletion, afatinib appears to provide better efficacy.