AUTHOR=Van Assche Katrijn , Ferdinande Liesbeth , Lievens Yolande , Vandecasteele Katrien , Surmont Veerle TITLE=EGFR Mutation Positive Stage IV Non-Small-Cell Lung Cancer: Treatment Beyond Progression JOURNAL=Frontiers in Oncology VOLUME=4 YEAR=2014 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2014.00350 DOI=10.3389/fonc.2014.00350 ISSN=2234-943X ABSTRACT=

Non-small-cell lung cancer (NSCLC) is the leading cause of death from cancer for both men and women. Chemotherapy is the mainstay of treatment in advanced disease, but is only marginally effective. In about 30% of patients with advanced NSCLC in East Asia and in 10–15% in Western countries, epidermal growth factor receptor (EGFR) mutations are found. In this population, first-line treatment with the tyrosine kinase inhibitors (TKIs) erlotinib, gefitinib, or afatinib is recommended. The treatment beyond progression is less well-defined. In this paper, we present three patients, EGFR mutation positive, with local progression after an initial treatment with TKI. These patients were treated with local radiotherapy. TKI was temporarily stopped and restarted after radiotherapy. We give an overview of the literature and discuss the different treatment options in case of progression after TKI: TKI continuation with or without chemotherapy, TKI continuation with local therapy, alternative dosing or switch to next-generation TKI or combination therapy. There are different options for treatment beyond progression in EGFR mutation positive metastatic NSCLC, but the optimal strategy is still to be defined. Further research on this topic is ongoing.