Management of EGFR-mutated non-small-cell lung cancer: practical implications from a clinical and pathology perspective

Current oncology

D. Ionescu¹  A. Karsan¹  B.S. Sheffield¹  R. Sangha²  C. Butts²  R.A. Juergens³  S. Kamel-Reid⁴  M. Pakkal⁴  M. Cabanero⁴  M.S. Tsao⁴  M. Sukhai⁴ 

[1] BC Cancer Agency;Cross Cancer Institute;Juravinski Cancer Centre, McMaster University;Princess Margaret Cancer Centre, University Health Network

关键词: Lung adenocarcinoma;    EGFR;    resistant mutations;    re-biopsies;    liquid biopsies;   

DOI  :  10.3747/co.24.3524

学科分类：肿瘤学

来源: Multimed, Inc.

【 摘 要 】

Starting in the early 2000s, non-small-cell lung cancer (nsclc) subtypes have evolved from being histologically described to molecularly defined. Management of lung adenocarcinomas now generally requires multiple molecular tests at baseline to define the optimal treatment strategy. More recently, second biopsies performed at progression in patients treated with tyrosine kinase inhibitors (tkis) have further defined the continued use of molecularly targeted therapy.In the present article, we focus on one molecular subtype:EGFR- mutated nsclc. For that patient population,multiple lines of tki therapy are now available either clinically or in clinical trials. Each line of treatment is guided by the specific mutations (for example, L858R, T790M, C797S) identified inEGFR.We first describe the various mechanisms of acquired resistance toEGFRtki treatment. We then focus on strategies that clinicians and pathologists can both use during tissue acquisition and handling to optimize patient results. We also discuss future directions for the molecular characterization of lung cancers with driver mutations, including liquid biopsies. Finally, we provide an algorithm to guide treating physicians managing patients withEGFR- mutated nsclc. The same framework can also be applied to other molecularly defined nsclc subgroups as resistance patterns are elucidated and additional lines of treatment are developed.

【 授权许可】

Unknown