Management of NSCLC Disease Progression After First-Line EGFR Tyrosine Kinase Inhibitors: What Are the Issues and Potential Therapies?

Drugs. 2016 May;76(8):831-40. doi: 10.1007/s40265-016-0578-z.

Abstract

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) represent the standard of care for advanced non-small cell lung cancer (NSCLC) patients whose tumor harbors an activating EGFR mutation. The vast majority of patients will experience disease control with an EGFR-TKI but inevitably all patients will progress, often within a year of treatment. There is no current standard of care for this scenario but, in clinical practice, most of the patients will be offered platinum-based doublet chemotherapy. In some situations, continuation of the EGFR-TKI beyond radiological progression, with or without use of local treatments in case of oligo-progressive disease, represents a reasonable therapeutic option. The aim of this review is to describe the different treatment strategies that have been developed to tackle progression on EGFR-TKIs, including specific clinical scenarios and novel agents designed to tackle the common T790M resistance mutation.

Publication types

  • Review

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use
  • Animals
  • Antineoplastic Agents / therapeutic use*
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Disease Progression
  • Drug Resistance, Neoplasm / genetics
  • Drug Therapy, Combination
  • ErbB Receptors / antagonists & inhibitors*
  • Humans
  • Immunotherapy
  • Lung Neoplasms / drug therapy*
  • Mice
  • Molecular Targeted Therapy
  • Mutation
  • Platinum Compounds / therapeutic use
  • Protein Kinase Inhibitors / therapeutic use*
  • Randomized Controlled Trials as Topic

Substances

  • Angiogenesis Inhibitors
  • Antineoplastic Agents
  • Platinum Compounds
  • Protein Kinase Inhibitors
  • ErbB Receptors