Optimizing management of stage IV EGFR mutant non-small cell lung cancer in Asia: An expert opinion

Abstract

Lung cancer is Asia's most prevalent cancer, accounting for the highest global patient share. A significant number of non-small cell lung cancer (NSCLC) patients in Asia exhibit mutations in the epidermal growth factor receptor (EGFR). Although clinical outcomes are improving with newer therapies, challenges persist in the effective management of EGFR mutant (EGFRm) NSCLC. Given the substantial disease burden, understanding the current diagnostic and treatment patterns for EGFRm NSCLC from an Asian perspective is essential. This expert opinion presents recommendations from Asian experts on molecular testing and treatment of first-line and second-line EGFRm NSCLC. The recommendations aim to optimize patient outcomes by providing a comprehensive approach to diagnosis and management, considering the high prevalence of EGFR mutations in the Asian population. The experts discussed and recommended approaches for optimal management of EGFRm NSCLC. Next-generation sequencing (NGS) testing is recommended to be included in the reimbursement scheme, and the turnaround time of testing should be shortened, considering the high burden of the disease in Asia. The panel recommended careful selection of patients for osimertinib+chemotherapy or lazertinib+amivantamab based on safety and efficacy profile, patient age, and disease status. While the panel agreed that osimertinib+chemotherapy is acceptable for these patients, dose adjustment and careful patient selection are recommended to optimize safety outcomes. For lazertinib+amivantamab, measures to mitigate adverse events such as the use of pre-medication with steroids, prophylactic anticoagulants, and dose modification are recommended. For patients progressing on one of the combination regimens, experts recommended repeat NGS testing and continued treatment with chemotherapy.