4
Treatment
Recommendation 1.6
➤ For patients with a sensitizing (L858R/exon 19 deletion) EGFR
mutation with stage IV NSCLC and a performance status of 3, who have
not had previous systemic therapy, monotherapy with an EGFR tyrosine
kinase inhibitor may be given, with the choice dependent on access
and toxicity profile of each agent (Weak recommendation; IC-L).
Recommendation 1.7
➤ For patients with an activating EGFR mutation other than exon 20
insertion mutations, T790M, L858R or exon 19 deletion, (e.g.,
G719X, L861Q, S768I), and a performance status of 0–2, who have
not had previous systemic therapy, clinicians may offer afatinib
monotherapy (Moderate recommendation; IC-L) or osimertinib (Weak
recommendation; IC-L) or standard treatment based on the ASCO/OH
non-driver mutation guideline (Moderate recommendation; IC-L).
Recommendation 1.8
➤ For patients with any activating EGFR mutation, regardless of PD-L1
expression levels (including exon 20 insertion mutations), single
agent immunotherapy should not be used as first-line therapy
(Moderate recommendation; IC-L).
Recommendation 1.9
➤ For patients with an exon 20 insertion mutation causing resistance to
first- and second-generation EGFR tyrosine kinase inhibitors, clinicians
may offer platinum doublet chemotherapy with or without bevacizumab
or standard treatment outlined in the ASCO/OH non-driver mutation
guideline may be offered (Moderate recommendation; IC-L).
EGFR Second-line
Recommendation 2.1
➤ For patients with a sensitizing (L858R/Ex19del) EGFR mutation
with stage IV NSCLC and a performance status of 0-2 who have
had previous EGFR targeted therapy (except osimertinib) and
subsequently have an EGFR T790M resistance mutation, clinicians
should recommend osimertinib (Strong recommendation; EB-B-H).
Recommendation 2.2
➤ For patients with any EGFR mutation whose disease has progressed
on EGFR tyrosine kinase inhibitors with no T790M mutation OR whose
disease has progressed on osimertinib, clinicians may treat based on
ASCO/OH non-driver mutation guideline (Moderate recommendation;
IC-L).
