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Current Oncology
Volume 24
Issue 2
10.3747/co.24.3524
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Review

Management of Egfr-Mutated Non-Small-Cell Lung Cancer: Practical Implications from a Clinical and Pathology Perspective

by
M. Cabanero
1,†,
R. Sangha
2,†,
B.S. Sheffield
3,†,
M. Sukhai
1,†,
M. Pakkal
1,†,
S. Kamel-Reid
1,
A. Karsan
3,
D. Ionescu
3,
R.A. Juergens
4,
C. Butts
2,* and
M.S. Tsao
1,*
1
Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
2
Cross Cancer Institute, Edmonton, AB, Canada
3
BC Cancer Agency, Vancouver, BC, Canada
4
Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally as first co-authors to the present work.
Curr. Oncol. 2017, 24(2), 111-119; https://doi.org/10.3747/co.24.3524
Submission received: 2 January 2017 / Revised: 5 February 2017 / Accepted: 7 March 2017 / Published: 1 April 2017

Abstract

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 in EGFR. We first describe the various mechanisms of acquired resistance to EGFR tki 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 with EGFR-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.
Keywords: lung adenocarcinoma; EGFR; resistant mutations; re-biopsies; liquid biopsies lung adenocarcinoma; EGFR; resistant mutations; re-biopsies; liquid biopsies

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MDPI and ACS Style

Cabanero, M.; Sangha, R.; Sheffield, B.S.; Sukhai, M.; Pakkal, M.; Kamel-Reid, S.; Karsan, A.; Ionescu, D.; Juergens, R.A.; Butts, C.; et al. Management of Egfr-Mutated Non-Small-Cell Lung Cancer: Practical Implications from a Clinical and Pathology Perspective. Curr. Oncol. 2017, 24, 111-119. https://doi.org/10.3747/co.24.3524

AMA Style

Cabanero M, Sangha R, Sheffield BS, Sukhai M, Pakkal M, Kamel-Reid S, Karsan A, Ionescu D, Juergens RA, Butts C, et al. Management of Egfr-Mutated Non-Small-Cell Lung Cancer: Practical Implications from a Clinical and Pathology Perspective. Current Oncology. 2017; 24(2):111-119. https://doi.org/10.3747/co.24.3524

Chicago/Turabian Style

Cabanero, M., R. Sangha, B.S. Sheffield, M. Sukhai, M. Pakkal, S. Kamel-Reid, A. Karsan, D. Ionescu, R.A. Juergens, C. Butts, and et al. 2017. "Management of Egfr-Mutated Non-Small-Cell Lung Cancer: Practical Implications from a Clinical and Pathology Perspective" Current Oncology 24, no. 2: 111-119. https://doi.org/10.3747/co.24.3524

APA Style

Cabanero, M., Sangha, R., Sheffield, B. S., Sukhai, M., Pakkal, M., Kamel-Reid, S., Karsan, A., Ionescu, D., Juergens, R. A., Butts, C., & Tsao, M. S. (2017). Management of Egfr-Mutated Non-Small-Cell Lung Cancer: Practical Implications from a Clinical and Pathology Perspective. Current Oncology, 24(2), 111-119. https://doi.org/10.3747/co.24.3524

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