Prof. Lu Liqin: Whole-process management of EGFR mutation-positive NSCLC

In May, enjoy the beautiful scenery of West Lake and the scenery of Jiangnan.

On May 14-16, 2021, the 5th Hangzhou Xianghu International Breast Cancer Summit (HXIBCS) and the 6th Hangzhou Xianghu Breast Cancer Forum for Young and Middle-aged People will be held in beautiful Hangzhou.

During the special session of the Zhejiang Medical Association Cancer Chemotherapy and Biological Therapy Annual Conference, famous domestic experts and scholars were invited to conduct in-depth discussions on the latest research progress in the field of solid tumors.

After the meeting, Yimaitong was fortunate to invite Professor Lu Liqin, Director of the Department of Oncology, Zhejiang Provincial People's Hospital, to share the full management strategy of EGFR mutation-positive non-small cell lung cancer (NSCLC).

Professor Lu Liqin Director, Department of Oncology, Zhejiang Provincial People's Hospital, Director, Chinese Society of Clinical Oncology (CSCO), Member, Rehabilitation and Palliative Committee of China Anti-Cancer Association, Director, Zhejiang Anticancer Association, Director, Rehabilitation Medicine, Zhejiang Province Member, Zhejiang Provincial Medical Association Oncology Professional Committee Deputy Chairman, Zhejiang Medical Association Chemotherapy and Targeting Professional Committee Deputy Chairman, Zhejiang Medical Association Oncology Precision and Targeting Committee Deputy Chairman Zhejiang Integrated Traditional Chinese and Western Medicine Oncology Committee The vice chairman has visited the MD Anderson Cancer Center and Harvard Medical School in the United States, and has rich clinical experience in tumor diagnosis and tumor treatment.

Yimaitong: EGFR mutation-positive NSCLC has experienced three generations of tyrosine kinase inhibitors (TKIs).
From the perspective of overall management, please talk about how to choose EGFR-TKI for treatment? Professor Lu Liqin: CSCO guidelines recommend that TKI drugs are the first choice for the treatment of EGFR mutation-positive NSCLC, including first-generation, second-generation and third-generation TKI drugs.
Currently, the recommendation level of the three drugs is level I (Class 1A evidence).

Related clinical studies have shown that the median progression-free survival (PFS) of first-line EGFR-TKI treatment is 10-11 months; FLAURA studies have shown that the third-generation EGFR-TKI osimertinib significantly prolongs the PFS ( 18.
9 vs 10.
2 months, P＜0.
001) and OS (38.
6 vs 31.
8 months, P=0.
0462), it can be seen that the efficacy of the third-generation EGFR-TKI is better.

At present, the third-generation EGFR-TKI is a better choice, but it is necessary to comprehensively consider the patient's condition and economic factors to make a choice that is more beneficial to the patient.

Yimaitong: What is the difference in the efficacy of EGFR-TKI for EGFR exon 19 deletion and 21 exon mutation? How to choose a first-line treatment plan? Professor Lu Liqin: In the population of EGFR mutations, the mutation sites are different.
The most classic ones are the deletion of exon 19 and the L858R mutation of exon 21, accounting for about 95%.

It also includes rare mutations in exon 18 and refractory mutations in exon 20.

The mutation site is different, and its biological behavior is different, so the effect of EGFR-TKI treatment is also different.

At present, the deletion of exon 19 is called a type of mutation, and the deletion of L858R in exon 21 is called a type of mutation.

From the perspective of efficacy, one to three generations of EGFR-TKI have good benefits for PFS and OS with exon 19 deletion.
Therefore, EGFR-TKI monotherapy can be used for exon 19 deletion.

EGFR-TKI treatment of PFS with L858R mutation in exon 21 is not very satisfactory, so the first-generation EGFR-TKI combined with anti-vascular drug therapy mode is considered; because clinical studies have shown that the third-generation EGFR-TKI combined with other drugs has not reached the expected therapeutic effect, it is generally not Select the combination therapy mode.

Yimaitong: For the first-line treatment of advanced lung cancer with EGFR mutations, what are the directions for future exploration? Professor Lu Liqin: The first, second, and third-generation EGFR-TKIs have good curative effects and are widely used in clinical practice.
Among them, the third-generation EGFR-TKI has better curative effects.

However, there are still many problems that need to be solved urgently, such as what is the resistance mechanism of the third-generation EGFR-TKI and how to carry out the follow-up treatment after resistance.
These are the directions for further research and exploration in the future.