Strategy on Patients with EGFR Mutation

摘要: The use of EGFR TKIs in patients harboring classical mutations results response rates (ORR), median progression-free survival (PFS), and overall the order 70 %, 12 months, 2 years, respectively. First-line treatment is preferred as ORR, PFS, quality life are improved compared to chemotherapy. Gefitinib erlotinib referred first-generation TKIs. second-generation afatinib dacomitinib exhibit irreversible binding ATP inhibit multiple receptors ErbB/HER receptor family. Studies evaluating their potential superiority over underway. All eventually develop resistance. A minority primary resistant, i.e., not responding progressing within 3 months. Possible mechanisms include resistance (e.g., exon 20 insertions or T790M mutations), coexisting genetic alterations KRAS mutations, MET amplification), germline alteration proapoptotic proteins. Secondary mediated by mutation 50–60 % cases. Further alternative pathway activation kinase switching histologic transformation. New options acquired rapidly evolving. However, premature termination TKI should be avoided it may lead “disease flare.” Early clinical phase I/II studies with third-generation TKIs, which selectively bind sensitizing well showed encouraging 28–64 %. Adjuvant therapy increased disease-free survival, but further need awaited.