Treatment of advanced non-small-cell lung cancer with epidermal growth factor receptor (EGFR) mutation or ALK gene rearrangement: results of an international expert panel meeting of the Italian Association of Thoracic Oncology.
The availability of targeted drugs has made the assessment of the EGFR mutation and ALK rearrangement critical in choosing the optimal treatment for patients with advanced non-small-cell lung cancer (NSCLC). In May 2013, the Italian Association of Thoracic Oncology (AIOT) organized an International Experts Panel Meeting to review strengths and limitations of the available evidence for the diagnosis and treatment of advanced NSCLC with EGFR or anaplastic lymphoma kinase (ALK) alterations and to discuss implications for clinical practice and future clinical research. All patients with advanced NSCLC, with the exclusion of pure squamous cell carcinoma in former or current smokers, should be tested for EGFR mutations and ALK rearrangements before decisions are made on first-line treatment. First-line treatment of EGFR-mutated cases should be with an EGFR tyrosine kinase inhibitor (TKI). Any available agent (gefitinib, erlotinib, or afatinib) can be used, until further data from comparative studies may better guide TKI selection. As general rule, and when clinically feasible, results of EGFR mutational status should be awaited before starting first-line treatment. Panelists agreed that the use of crizotinib is justified in any line of treatment. Although solid evidence supporting the continuation of EGFR TKIs or crizotinib beyond progression is lacking, in some cases (minimal, asymptomatic progression, or oligoprogression manageable by local therapy), treatment continuation beyond progression could be justified. Experimental strategies to target tumor heterogeneity and to treat patients after failure of EGFR TKIs or crizotinib are considered high-priority areas of research. A number of relevant research priorities were identified to optimize available treatment options.
Division of Medical Oncology, San Giuseppe Moscati Hospital, Avellino, Italy. Electronic address: cgridelli@libero.it.
Cesare
C
Gridelli
Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy.
Filippo
F
de Marinis
Medical Oncology Department, Civil Hospital of Livorno, Istituto Toscano Tumori, Livorno, Italy.
Federico
F
Cappuzzo
Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione G.Pascale IRCCS, Napoli, Italy.
Massimo
M
Di Maio
University of Colorado Cancer Center, Aurora, CO.
Fred R
FR
Hirsch
Department of Clinical Oncology, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Tony
T
Mok
Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale "F. Magrassi e A. Lanzara," Seconda Università degli Studi di Napoli, Napoli, Italy.
Floriana
F
Morgillo
Medical Oncology Service, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona (Barcelona), Spain.
Rafael
R
Rosell
Sarah Cannon Research Institute, Nashville, TN.
David R
DR
Spigel
Graduate Institute of Oncology and Cancer Research Center, National Taiwan University and Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan.
James Chih-Hsin
JC
Yang
Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale "F. Magrassi e A. Lanzara," Seconda Università degli Studi di Napoli, Napoli, Italy.
Fortunato
F
Ciardiello
D000077548:Anaplastic Lymphoma Kinase; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology; D018450:Disease Progression; D066246:ErbB Receptors / Q000235:genetics; D015321:Gene Rearrangement; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D058990:Molecular Targeted Therapy; D009154:Mutation; D047428:Protein Kinase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics
D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases
ALK rearrangement; Epidermal growth factor receptor mutation; Non–small-cell lung cancer