Abstract
AimTo stablish a consensus on the treatment strategy for advanced non–small-cell lung cancer (aNSCLC) with epidermal growth factor receptor mutation (EGFRm) in Spain.MethodsAfter a systematic literature review, the scientific committee developed 33 statements in 4 fields: molecular diagnosis (10 items); histologic profile and patient clinical characteristics (7 items); first-line (1L) treatment in EGFRm aNSCLC (8 items); and subsequent-line treatment (8 items). A panel of 31 experts completed 2 Delphi online questionnaires rating their degree of agreement/disagreement for each statement through a 1–9 range scale (1–3 = disagree, 7–9 = agree). Consensus was reached if 2/3 of the participants are in the median range.ResultsIn the first Delphi round consensus was achieved for 24/33 of the statements. One of the assertions was deleted, proceeding to a second round with the eight remaining questions with no consensus or in the range of indeterminacy. Determination of the EGFR status from tissue and analysis of the different biomarkers are two important variables that influenced treatment decision in patients with aNSCLC. 1L treatment should be the best therapeutic option, independently of the subsequent lines of treatment. For patients with the most common activating mutations osimertinib was considered the most efficient and safe 1L option. In case of disease progression, a new biopsy was needed.ConclusionsA consensus document is proposed to optimize the treatment strategy for untreated patients with a NSCLC with EGFR sensitizing mutations.
Highlights
Non-small cell lung cancer (NSCLC) account for 85%–90% of lung cancer, being adenocarcinoma the most common subtype
Epidermal growth factor receptor (EGFR) mutation (EGFRm) testing is recommended in all patients with advanced non-squamous cell carcinoma, it is not recommended in patients with an unequivocal diagnosis of squamous cell carcinoma with the exception of never/former light smokers (< 15 pack years)
The current Delphi study shows that a high degree of consensus exists among experts on the relevance to obtain molecular diagnosis before starting any treatment in advanced NSCLC (aNSCLC), how these patients should be treated in the 1L setting according to the presence of EGFRm, and how the 1L therapy decision in these population may influence subsequent therapeutic approaches
Summary
Non-small cell lung cancer (NSCLC) account for 85%–90% of lung cancer, being adenocarcinoma the most common subtype. Epidermal growth factor receptor (EGFR) mutations are found in ∼10%–12% of Caucasians with adenocarcinoma and are more frequent in never smokers, females and in patients of East Asian ethnicity [1, 2]. EGFR mutation (EGFRm) testing is recommended in all patients with advanced non-squamous cell carcinoma, it is not recommended in patients with an unequivocal diagnosis of squamous cell carcinoma with the exception of never/former light smokers (< 15 pack years). The discovery of EGFRm and development of EGFR tyrosine kinase inhibitors (TKIs) have achieved a paradigm shift in treatment strategy of advanced NSCLC (aNSCLC). Several randomized phase III studies have revealed that treatment with first- or second-generation EGFR-TKIs results in an improved progression-free survival (PFS) compared to standard chemotherapy in treatment. The optimal treatment sequence for patients with EGFRm aNSCLC continues to evolve, related largely to an increasing number of breakthroughs and studies in this field
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