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

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

84 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 Overactive EGFR mutation Guide 21 lists treatments options for overactive EGFR mutations. These options may help you no matter your performance status. First-line treatment Your options may be erlotinib, afatinib, gefitinib, or osimertinib. These treatments are targeted therapies. This mutation may be found while you are on first-line chemotherapy. In this case, you may stop chemotherapy early and start targeted therapy. Otherwise, you may start targeted therapy as a maintenance treatment after completing chemotherapy. Next-in-line treatment The cancer may worsen while on first-line treatment. If it worsens on erlotinib, afatinib, or gefitinib, T790M testing is advised. Results will help to plan treatment. If the cancer doesn’t worsen much, one option may be to stay on your first-line treatment. Local treatment may be added to first-line treatment. It is sometimes used when the metastasis is within a confined area, such as the brain or adrenal gland. If you need to switch treatment, osimertinib may be received. It is given if not received before and a T790M mutation is present. Platinum-based chemotherapy may be another option. The T790M mutation must not be present or the cancer worsened while on osimertinib. Chemotherapy is often used if there are multiple metastatic tumors causing symptoms. Read Guide 26 to learn more options for Adenocarcinoma, large cell, and unknown types . Read Guide 27 to learn more options for Squamous cell carcinoma .  7 Metastatic cancer Overactive EGFR mutation Guide 21. Treatment for EGFR mutation First-line treatment What are the options? • Erlotinib • Gefitinib • Afatinib • Osimertinib Next-in-line treatment First-line treatment What are the options? Erlotinib, afatinib, or gefitinib • Stay on first-line treatment ± local treatment • Switch to osimertinib if T790M present and not previously given • Start treatment for histologic type if T790M not present ◦◦ Adenocarcinomas, large cell, unknown types (see Guide 26 ) ◦◦ Squamous cell carcinoma (see Guide 27 ) Osimertinib • Stay on osimertinib ± local treatment • Start treatment for histologic type ◦◦ Adenocarcinomas, large cell, unknown types (see Guide 26 ) ◦◦ Squamous cell carcinoma (see Guide 27 )

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