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Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 10/2019

01-10-2019 | NSCLC | Review Article

Strategies to overcome acquired resistance to EGFR TKI in the treatment of non-small cell lung cancer

Authors: J. Gao, H.-R. Li, C. Jin, J.-H. Jiang, J.-Y. Ding

Published in: Clinical and Translational Oncology | Issue 10/2019

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Abstract

Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) represents a paradigm shift in the treatment of non-small cell lung cancer (NSCLC) patients and has been the first-line therapy in clinical practice. While erlotinib, gefitinib and afatinib have achieved superior efficacy in terms of progression-free survival and overall survival compared with conventional chemotherapy in NSCLC patients, most people inevitably develop acquired resistance to them, which presents another challenge in the treatment of NSCLC. The mechanisms of acquired resistance can be classified as three types: target gene mutation, bypass signaling pathway activation and histological transformation. And the most common mechanism is T790M which accounts for approximately 50% of all subtypes. Many strategies have been explored to overcome the acquired resistance to EGFR TKI. Continuation of EGFR TKI beyond progressive disease is confined to patients in asymptomatic stage when the EGFR addiction is still preserved in some subclones. While the combination of EGFR TKI and chemotherapy or other targeted agents has improved the survival benefit in EGFR TKI resistant patients, there are controversies within them. The next-generation EGFR TKI and immunotherapy represent two novel directions for overcoming acquired resistance and have achieved promising efficacy. Liquid biopsy provides surveillance of the EGFR mutation by disclosing the entire genetic landscape but tissue biopsy is still indispensable because of the considerable rate of false-negative plasma.
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Metadata
Title
Strategies to overcome acquired resistance to EGFR TKI in the treatment of non-small cell lung cancer
Authors
J. Gao
H.-R. Li
C. Jin
J.-H. Jiang
J.-Y. Ding
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 10/2019
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-019-02075-1

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