MSKCC medical oncologist Dr. Greg Riely reviews the optimal first line treatment of patients with an EGFR mutation-positive advanced lung cancer.

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When we identify a patient with an EGFR mutant form of lung cancer, we know that there’s a mutation in their tumor. That helps us figure out the first line of treatment — the initial therapy for patients. Now, some of the initial work identifying drugs for patients with EGFR mutant lung cancer focused on patients who had had multiple prior therapies, but over the last five years we’ve had a luxury of big, randomized clinical trials where we take hundreds of patients and randomize half of them to treatment with chemotherapy, and half of them to treatment with EGFR tyrosine-kinase inhibitors — drugs like erlotinib, gefitinib and afatinib.

When we look at those trial results, we see really remarkable improvements in the chance of the tumor shrinking, so that it’s much more likely that with these oral treatments for lung cancer, like erlotinib, gefitinib, or afatinib, that the tumors will shrink — much more likely than with chemotherapy. Importantly, it’s also shown that, from these trials, that we see much longer time until the cancer grows. So, taking a pill leads to longer disease control than we see with IV chemotherapies.