EGFR mutations account for about 10–15% of lung cancer cases in the United States. Biomarker testing allows oncologists to choose targeted treatments for these types of lung cancer.
Non-small cell lung cancer (NSCLC) accounts for a majority of lung cancer cases. People with NSCLC may have adenocarcinoma, squamous cell carcinoma, or large cell carcinoma. Understanding the exact type of cancer and its genetic markers allows an oncologist to use targeted treatments.
Biomarker testing is also known as genetic testing. After receiving a diagnosis, a person should undergo biomarker testing as soon as possible. Biomarker testing involves taking a sample of the tumor and checking the cancer cells for genetic mutations.
There are specific changes that can occur in some lung cancer cells. These changes provide a person’s healthcare team with more information about the genetic mutation that led to cancer.
One of the more common gene mutations that occurs is in the epidermal growth factor receptor (EGFR) gene. Specific treatments are available for people with EGFR-positive NSCLC. These targeted therapies are more effective and often have fewer side effects.
EGFR is a protein that is present on the surface of cells. When it acts normally, it regulates how cells grow and replicate. A mutation in the EGFR gene causes cells to grow too quickly, resulting in cancer cells.
Different mutations can affect the EGFR gene. Currently, there are more than 200 known possible mutations. The most common types of EGFR mutations will respond to similar treatments. About 10% of people with EGFR-positive NSCLC will have a more rare mutation, which may mean that they do not consistently respond to the therapies that doctors use for this type of cancer.
The stage of cancer will determine the treatment options. In most cases, people with NSCLC do not receive a diagnosis until the cancer has reached stage four.
Advanced EGFR-positive lung cancer has different treatments than other types of NSCLC. However, the treatments are similar for early EGFR-positive NSCLC and other types of NSCLC.
TKIs
Tyrosine kinase inhibitors (TKIs) are a type of oral medication that helps reduce the action of the EGFR protein. Blocking the growth receptor factor stops or slows cancer cell growth. EGFR TKIs can serve as the first-line treatment for stage 3 or 4 cancer — either before or after chemotherapy.
Combination therapy
Combination therapy involves the use of a TKI alongside an anti-angiogenesis inhibitor. This type of inhibitor reduces blood flow to a tumor, blocking its ability to grow.
Chemotherapy
In the past, chemotherapy was a first-line treatment for advanced stages of cancer. Following biomarker testing, oncologists often treat EGFR-positive lung cancer with TKIs first. Chemotherapy may still form a part of the treatment.
Surgery
Oncologists often recommend surgery for people with NSCLC in an early stage, regardless of whether the cancer is EGFR-positive. If a person is well enough to have surgery, this may be the first step if the cancer has not spread.
Radiation therapy
Radiation therapy has potential as a treatment at any stage. In EGFR-mutated cancer, it may play a role when TKIs are not working. Research shows that even when TKIs do work, radiation therapy may still be helpful. Radiation therapy could
Oncologists stage NSCLC based on where the cancer is, the tumor size, and whether the cancer has spread. They take into account the stage of lung cancer and the overall health of a person when determining the best treatment options.
In stages 3 and 4, a person with EGFR-positive NSCLC will have more specific treatment options. In stages 0, 1, and 2, the treatment will be similar to that for any other type of early stage NSCLC.
Stage 0
Doctors do not often detect NSCLC at stage 0. However, when they do, they will typically remove or destroy the lung cancer tumors using surgery, radiation therapy, or other procedures.
Stage 1 or 2
At stage 1 or 2, surgery to remove the tumor is common as long as the person is healthy enough. Chemotherapy may follow the surgery. If surgery is not an option, doctors may recommend radiation therapy.
Doctors treat NSCLC at this stage in a similar way regardless of whether it is EGFR-positive.
Stage 3
There are many factors to consider when determining the best treatment for stage 3 NSCLC. At this stage, the tumor is larger, and the cancer may have spread near the area where it started.
Surgery is often not enough to remove or manage the cancer. Chemotherapy and radiation therapy may be necessary to try shrinking the tumor.
A person’s healthcare team might decide on targeted therapy at this stage. Sometimes, targeted therapy with an EGFR TKI may be an option before or after chemotherapy.
Stage 4
Stage 4 lung cancer is when the cancer has spread beyond the primary cancer site.
An EGFR TKI medication will be part of the treatment for stage 4 NSCLC with an EGFR mutation. Different TKIs are available, and the individual and their doctor will discuss the options to determine the best one.
EGFR TKI medications may work for months or years. Although these drugs are not a cure, they can help slow or stop the growth of the cancer. Research shows that EGFR TKIs are a better first-line treatment than chemotherapy.
At some point, the cancer may start to grow again. Due to this, oncologists generally recommend repeat biomarker testing. There may be a change in the genes of the cancer cell, and a better treatment may be available.
Research is ongoing to learn more about EGFR mutations. There are questions about why some do not respond to EGFR TKIs.
A variety of TKI medications is available. The EGFR inhibitor a person receives will involve different factors, such as the oncologist’s preference, the specific lung cancer, and treatment goals. However, evidence suggests that most people often tolerate and respond well to osimertinib. As such, many people will receive osimertinib as their first EGFR inhibitor.
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While TKIs are a standard treatment for EGFR-positive lung cancer, people may develop resistance to these medications. As such, it is important to better understand the potential mechanisms of resistance and develop novel treatments that can target or bypass these resistance mechanisms.
Ongoing studies are also investigating how best to use chemotherapy, radiation therapy, and other medications. These other therapies may still play an important role by helping TKIs work even better.
Some FAQs about treatments for EGFR-positive lung cancer may include:
What types of drugs are EGFR inhibitors?
Treatment options for EGFR-positive lung cancer may include tyrosine kinase inhibitors (TKIs) and anti-angiogenesis inhibitors. TKIs reduce the action of the EGFR protein and anti-angiogenesis inhibitors block the growth of blood vessels that support tumor growth.
What is the best treatment for EGFR positive lung cancer?
Treatment options will vary depending on the individual and the stage of cancer. Treatments will typically include medications, chemotherapy, surgery, and radiation therapy.
What is EGFR therapy?
EGFR therapy refers to medications that bind to the EGFR protein and help to slow or stop cell growth. EGFR is present on the surface of some cells and can cause cells to divide when epidermal growth factor binds to it. Examples of EGFR therapy drugs include afatinib, dacomitinib, erlotinib, gefitinib, and osimertinib.
What is target EGFR?
EGFR targeted therapy is another name for EGFR therapy. This term refers to the fact that these drugs specifically target and bind to the EGFR protein.
Biomarker testing is an important part of treatment for NSCLC. EGFR mutations are one of the most common gene changes that occur in NSCLC.
In the early stages of the disease, the treatment for EGFR-positive lung cancer is similar to that for other types of lung cancer. In the advanced stages, targeted treatments for EGFR-positive NSCLC are available. Oncologists routinely use TKIs as the first-line treatment. Other treatments may include surgery, chemotherapy, radiation therapy, and anti-angiogenesis inhibitors.
The first steps are to determine the stage of cancer and carry out biomarker testing. The healthcare team can use this information to discuss the best treatment options with the person.