NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

50 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 5 Overview of cancer treatments Targeted therapy information on who should receive these drugs is provided. Targeted therapy is often given when certain mutations are present. EGFR mutation Cell growth is started by growth signals. EGFR is one of the surface receptors in lung cancer cells that can trigger growth signals. Some people with lung cancer have gene mutations that cause EGFR to be overactive. With overactive EGFRs, new cancer cells form quickly. There are five medicines used to stop EGFRs from triggering growth signals. See Figure 17 . Erlotinib Erlotinib attaches to a part of EGFR that is within cells. This part of EGFR is a tyrosine kinase. It is a docking site for phosphate as it is moved from one molecule to another. Erlotinib blocks phosphate and stops EGFRs from completing their job. Thus, growth signals aren’t triggered by EGFRs. Erlotinib is made as a pill. It should be taken on an empty stomach. The dose given differs among people. Your doctor will decide the dose you need. Common side effects of erlotinib are rash; diarrhea; not feeling hungry; weakness; trouble breathing; and cough. You may have severe eye, skin, lung, kidney, or liver problems, but these are rare. Other rare events include tears in your gut and bleeding. Don’t take erlotinib if you are pregnant, trying to get pregnant, or breastfeeding. Gefitinib Gefitinib is the same type of drug as erlotinib. Gefitinib is made as a pill. It can be taken with or without food. It is usually taken once a day. The most common side effects of gefitinib are skin reactions and diarrhea. Serious side effects include a tear in your gut and eye problems. Figure 17 EGFR, ALK, ROS1 targets Some lung cancers have overactive surface receptors. These receptors help the cancer cells grow by triggering cell growth signals. Targeted therapy stops growth signals from these receptors. Copyright © 2017 National Comprehensive Cancer Network ® (NCCN ® ). L cetuximab erlotinib gefitinib afatinib osimertinib ALK crizotinib ceritinib alectinib brigatinib P cancer cells crizotinib ceritinib P EGFR P ROS1