Oral tyrosine kinase inhibitors in the first-line treatment of advanced non-small cell lung cancer

Introduction: In EGFR mutated advanced NSCLC, tyrosine kinase inhibitors are new valid options as first-line treatment. Gefitinib appears a valid alternative to chemotherapy as first-line therapy, in EGFR mutated elderly or unfit patients too, while erlotinib remains an option for subsequent lines of treatment. Areas covered: Areas covered in this review include two international trials, which evaluated erlotinib in chemo-naive EGFR mutated patients both in an Asian and caucasian population, showing a dramatic advantage in terms of progression-free survival and overall response rate as well as gefitinib. Results showed a good safety profile, with side effects of mild to moderate intensity, usually manageable with temporary interruption of treatment. Expert opinion: Investigating EGFR mutations is critical in order to obtain sufficient data. It has now become mandatory for molecular characterization, as part of baseline diagnostic procedures. This approach is also becoming increasingly important during progression of the disease as a sort of 'molecular follow up'. It plays a central role in the right choice of treatment, in an aim to give the best drug to the right patients, overcoming other well known prognostic factors.