Advanced EGFR Mutation-Positive Non-Small-Cell Lung Cancer: Case Report, Literature Review, and Treatment Recommendations

Background: Lung cancer is the leading cause of cancer mortality. Non-small-cell lung cancer (NSCLC) comprises up to 90% of all lung cancers. Conventional treatment for advanced NSCLC consists of chemotherapy and has a small impact on survival. Molecular targets, such as epidermal growth factor receptor (EGFR), involved in cell signaling have led to the development of new, targeted therapies over the past 15 years. Methods: Using a case report from our clinical practice, we review the literature and provide guidelines to the approach and management of advanced EGFR mutation-positive NSCLC. Results: Targeted and/or biologic (small molecules or monoclonal antibodies) cancer therapies have vaulted to the forefront of clinical research and therapeutic use. Our recommendation, backed by strong scientific evidence, is to treat patients with advanced or recurrent NSCLC harboring activating EGFR mutation with an EGFR tyrosine kinase inhibitor (TKI) as early as possible. Erlotinib is currently the drug of choice in the United States, although afatinib, due to its recent approval by the US Food and Drug Administration, will soon be available. Conclusions: Improved understanding of cell signaling pathways that control cellular proliferation, differentiation, and survival combined with our increased ability to screen for specific mutations that drive malignant transformation and oncogenic behavior, has altered our treatment of advanced NSCLC. We can now provide a more individualized approach associated with improved progression-free survival and quality of life.