3
Treatment
Note: unless otherwise listed, recommendations apply to patients with a performance status
of 0–2.
EGFR First-line
Recommendation 1.1
➤ For patients with a sensitizing (L858R/exon 19 deletion, with or
without a concomitant T790M mutation) EGFR mutation with stage IV
NSCLC and a performance status of 0–2 who have not had previous
systemic therapy, clinicians should offer osimertinib monotherapy
(Strong recommendation; EB-B-H).
Qualifying Statement: Although Recommendation 1.1 addresses many patients in the
target population, the guideline manuscript presents additional options that may be
reasonable, based on the evidence reviewed. This statement applies to all recommendations
with the word "should." In addition, use of osimertinib in patients previously treated with
adjuvant or consolidation tyrosine kinase inhibitors is not part of this guideline.
Recommendation 1.2
➤ For patients with a sensitizing (L858R/exon 19 deletion) EGFR
mutation with stage IV NSCLC and a performance status of 0–2,
previously untreated with systemic therapy and for whom osimertinib
is not available, clinicians may use combination gefitinib with doublet
chemotherapy (platinum/pemetrexed with maintenance pemetrexed)
(Moderate recommendation; EB-B-H).
Recommendation 1.3
➤ For patients with a sensitizing (L858R/exon 19 deletion) EGFR
mutation with stage IV NSCLC and a performance status of 0–2,
previously untreated with systemic therapy and for whom osimertinib
is not available, clinicians may use dacomitinib monotherapy
(Moderate recommendation; EB-B-H).
Recommendation 1.4
➤ For patients with a sensitizing (L858R/exon 19 deletion) EGFR
mutation with stage IV NSCLC and a performance status of 0–2,
who have not had previous systemic therapy, and do not have
access to osimertinib, clinicians may use monotherapy with afatinib
or erlotinib/bevacizumab or erlotinib/ramucirumab (Moderate
recommendation; EB-B-I).
Recommendation 1.5
➤ For patients with a sensitizing (L858R/exon 19 deletion) EGFR
mutation with stage IV NSCLC and a performance status of 0–2, who
have not had previous systemic therapy, and do not have access
to other regimens, clinicians may use monotherapy with gefitinib,
erlotinib, or icotinib (Moderate recommendation; EB-B-I).
