Treatment strategy optimization for patients with non-small-cell lung cancer harboring EGFR mutation: a Delphi consensus
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RESEARCH ARTICLE
Treatment strategy optimization for patients with non‑small‑cell lung cancer harboring EGFR mutation: a Delphi consensus D. Isla1 · J. de Castro2 · R. García‑Campelo3 · M. Majem4 · D. Vicente5 · O. Juan‑Vidal6 Received: 2 October 2020 / Accepted: 24 October 2020 © The Author(s) 2020
Abstract Aim To stablish a consensus on the treatment strategy for advanced non–small-cell lung cancer (aNSCLC) with epidermal growth factor receptor mutation (EGFRm) in Spain. Methods After a systematic literature review, the scientific committee developed 33 statements in 4 fields: molecular diagnosis (10 items); histologic profile and patient clinical characteristics (7 items); first-line (1L) treatment in EGFRm aNSCLC (8 items); and subsequent-line treatment (8 items). A panel of 31 experts completed 2 Delphi online questionnaires rating their degree of agreement/disagreement for each statement through a 1–9 range scale (1–3 = disagree, 7–9 = agree). Consensus was reached if 2/3 of the participants are in the median range. Results In the first Delphi round consensus was achieved for 24/33 of the statements. One of the assertions was deleted, proceeding to a second round with the eight remaining questions with no consensus or in the range of indeterminacy. Determination of the EGFR status from tissue and analysis of the different biomarkers are two important variables that influenced treatment decision in patients with aNSCLC. 1L treatment should be the best therapeutic option, independently of the subsequent lines of treatment. For patients with the most common activating mutations osimertinib was considered the most efficient and safe 1L option. In case of disease progression, a new biopsy was needed. Conclusions A consensus document is proposed to optimize the treatment strategy for untreated patients with a NSCLC with EGFR sensitizing mutations. Keywords Delphi · Non–small-cell lung cancer · Epidermal growth factor receptor · Tirosine kinase inhibitors
Introduction
* O. Juan‑Vidal [email protected] 1
Medical Oncology Department, University Hospital Lozano Blesa, IIS Aragón, Avda. San Juan Bosco, 15, 50009 Zaragoza, Spain
2
Medical Oncology Department, University Hospital La Paz-IDIPAZ, Madrid, Spain
3
Medical Oncology Unit, University Hospital A Coruña, A Coruña, Spain
4
Medical Oncology Unit, Hospital Santa Creu I Sant Pau, Barcelona, Spain
5
Medical Oncology Unit, University Hospital Virgen Macarena, Sevilla, Spain
6
Thoracic Oncology Unit, Department of Medical Oncology, Hospital Universitari I Politècnic La Fe, Av. Fernando Abril Martorell 106, 46026 Valencia, Spain
Non-small cell lung cancer (NSCLC) account for 85%–90% of lung cancer, being adenocarcinoma the most common subtype. Epidermal growth factor receptor (EGFR) mutations are found in ∼10%–12% of Caucasians with adenocarcinoma and are more frequent in never smokers, females and in patients of East Asian ethnicity [1, 2]. EGFR mutation (EGFRm) testing is recommended in all patients with advanced non-squamous cell carcino
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