Beyond EGFR TKI in EGFR-mutant Non-Small Cell Lung Cancer patients: Main challenges still to be overcome

Efficacy and safety of gefitinib during pregnancy: Case report and literature review

“…Indeed EGFR-TKIs at least double the response rate compared with cytotoxic chemotherapy in EGFR-mutated lung carcinoma. Hence EGFR-TKIs should be the first-choice treatment to both maximize probability of treatment response and then avoid a fetal salvage extraction at 28 weeks and complications associated with prematurity [3]. On the other hand, few data are available on EGFR-TKI side effects on the fetus during pregnancy.…”

“…gefitinib and erlotinib) prescription as first line-targeted therapy. Indeed EGFR-TKIs increase the progressionfree survival with fewer side effects than cytotoxic chemotherapy [3]. However pharmacological data for EGFR-TKIs in both pregnant women and fetuses as well as long term follow up of exposed children have not been reported.…”

Crosstalk analysis of pathways in breast cancer using a network model based on overlapping differentially expressed genes

“…Furthermore, the present study showed overlapping genes in all pathways. Among them, EGFR (35), IGF-1 (36), E2F3 (37) are associated with lung cancer, prostate cancer and other diseases, which may be helpful for the study of diseases by understanding of these pathways. Although the crosstalk between pathways was analyzed and the main pathway was identified, further evaluation of how the pathways effect each other would be worthwhile.…”

Successful empirical erlotinib treatment of a mechanically ventilated patient newly diagnosed with metastatic lung adenocarcinoma

“…In 2004, EGFR mutations were defined as predictors of the response of patients treated with the tyrosine kinase inhibitor gefitinib, which imparted a rapid and often dramatic clinical response [15,16]. These favorable preliminary results have been confirmed by randomized phase III trials, which have demonstrated that first-generation EGFR TKIs significantly improve the outcome by doubling the response rate (RR) and progression free survival (PFS) compared to chemotherapy [17]. Additionally, a meta-analysis showed that patients who received upfront EGFR TKI achieved a longer overall survival (OS) compared to upfront chemotherapy; however, differences did not reach statistical significance (30.5 months vs. 23.6 months; HR 0.94; 95% CI: 0.77-1.15; p = 0.57), mainly to the subsequent drugs cross-over [18].…”

“…Therefore, we suggests that in critically ill patients with a priori high probability of having an EGFR mutation, a strategy of "shoot first, ask later" might be reasonable. The probability of obtaining a response rate from empirical erlotinib in a never smoker or a former light smoker with a lung adenocarcinoma is around 17-35%, assuming 29-49% of EGFR mutation from epidemiologic studies [3] and 58-83% response rate to erlotinib from pivotal studies [17], which means a number needed to treat of 3-6 with this empirical approach. We want to state that this strategy should be employed only for patients who cannot wait for EGFR mutation status results due to their critical clinical situation because as the IPASS study has shown in EGFR wild-type tumors, frontline chemotherapy treatment is better than the EGFR TKI gefitinib [6].…”