Article and Video CATEGORIES

Cancer Journey

Search By

Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University

Chief of Hematology/Oncology
Medical Director of Memorial Cancer Institute

Lung Cancer Video Library - Spanish Language: Video #33 Current Standards and Leading Options for First-line Treatment of EGFR Mutation-Positive NSCLC
Tue, 02/14/2017 - 12:20
Luis Raez, MD FACP FCCP, Faculty, Board Member

Estándares actuales y opciones líderes para el tratamiento de primera línea de una mutación positiva del receptor del factor de crecimiento epidérmico (EGFR) en cáncer pulmonar de células no pequeñas.

 Current standards and leading options in first line treatment for a positive mutation in epidermal growth factor receptor (EGFR) in non-small cell lung cancer

 Dr. Luis Raez, MD FACP FCCP

Chief of Hematology/Oncology and Medical Director, Memorial Cancer Institute,
Clinical Associate Professor of Medicine, Florida International University



¿Cuál es el estándar o cuál es el tratamiento convencional para pacientes que tienen mutaciones EGFR? Eso creo que todos lo sabemos muy bien, porque hace 5 años que lo hacemos. Tenemos la suerte que cuando tenemos un paciente con mutaciones EGFR también tenemos tres o cuatro fármacos aprobados.

La primera es gefitinib, la segunda erlotinib, la tercera es afatinib, y hay países asiáticos que tienen icomatinib. Hay obviamente muchos más inhibidores de las tirosinas cinasa que están en desarrollo en muchos países. Pero en general estos son los agentes que tenemos, muchas veces la elección de estos agentes depende de la tradición. Por ejemplo, en el hemisferio oeste del mundo (Europa y Norte América), el único fármaco disponible era erlotinib y la mayoría de gente usa esta. En Asia, en 23-24 países gefitinib ha estado disponible por muchos años y están acostumbrados a hacer eso. Los mismo con icomatinib que se desarrolló en China e India. 

Muchas veces la elección de la droga depende de lo que uno está acostumbrado a hacer. Hay muy pocos estudios, solamente hay uno en carcinoma de células epidermoide que prueba que un fármaco puede ser mejor que otro. En el caso de afatinib contra erlotinib que hay un mejor beneficio con afatinib. En general también depende mucho de la compañía de seguros y otros factores para ver que agente se va a usar.

También la toxicidad es diferente, algunos de ellos son menos tóxicos que otros. Me refiero por ejemplo a las erupciones de la piel y a las diarreas. En general, las drogas más potentes como afatinib, que son inhibidores irreversibles de la tirosina cinasa, tienden a dar más diarreas y erupciones por lo que muchos médicos piensan que son mejores y las usan. Y hay otros médicos que piensan que no y no los usan porque también recuerden que hay pacientes mayores que de repente no van a tolerar las erupciones y la diarrea, por lo que tenemos que usar la toxicidad para ver que fármacos se van a usar en cada caso.



What is the standard treatment for patients with EGFR mutations? I think we all know it pretty well because we’ve been doing it for 5 years. We have been lucky to have patients with EGFR mutations and also have 3 to 4 approved drugs.

The first one is gefitinib, the second is erlotinib, the third one is afatinib, and in Asian countries they have icomatinib. There are obviously more tyrosine kinase inhibitors that are being developed in many countries. But in general, these agents are sometimes selected because of tradition. For example, in the western hemisphere (Europe and North America), the only approved drug was erlotinib, so most people use it. In 23-24 countries in Asia, they have been using gefitinib for many years and they are used to their reaction. The same with icomatinib that was developed in China and India.

Many times, the drug of choice depends on what the patient is used to. There are few trials, only one in epidermal cells cancer, that proves that a drug can be better than another one. In the case of afatinib and erlotinib, there a more benefits with afatinib. In general, it also depends on the insurance company and other factors to see which agent to use.

The toxicity is different, some of them are less toxic than others, but the effects are only skin rash and diarrhea. In general, the more powerful drugs like afatinib, which are irreversible tyrosine kinase inhibitors, give more rashes and diarrhea, so physicians think that it’s better and they use it more. In contrast, there are other doctors that think the side effects are not good, so they don’t use them, especially in elderly patients that cannot tolerate skin rashes or diarrhea. As you can see, we use toxicity to see which drugs are going to be used in each case.

Video Language

Next Previous link

Previous PostNext Post

Related Content

Mandarin LCVL
王林医生用普通话讨论重要的肺癌信息。这些信息包括靶向治疗、晚期疾病的症状、循环肿瘤 DNA、治疗方案等。我们鼓励您与社区中说普通话的人分享。 Dr. Lin Wang discusses important lung cancer information in Mandarin. This information includes targeted therapy, symptoms of advanced disease, circulating tumor DNA, treatment options, and more. We encourage you to share this with the Mandarin speakers in your community. To watch the complete Playlist visit:…;  
Tell your story!  Apply now for the Clinical Trials Experiences through Storytelling Program
We are excited to launch our third year of this program; tell your story and help us help others! Apply Online Now!     GRACE Patient Perspectives: Clinical Trials Experiences Storytelling Program Overview  
Blood Cancer OncTalk
Blood Cancer OncTalk was a live presentation that brought together top oncologists to discuss emerging concepts and treatment options in blood cancer. The program was chaired by Dr. Aaron Goodman, with the participation of Dr. Mazie Tsang, Hematologist / Oncologist; Dr. Autumn Jeong, Hematologist / Oncologist; Dr. Shaji Kumar, Hematologist / Oncologist; and Dr. Sridevi Rajeeve, Hematologist / Oncologist.

Forum Discussions

Hi Caregiver and welcome to Grace.  I'm sorry that you need to be here and hope we can help.  Osimertinib has better efficacy than gefitinib (including OS and reaching the brain)...

Hi Bob, Welcome to Grace.  I'm sorry about your sil.  Unfortunately, cancer becomes resistant to TKIs like tagrisso.  Sometimes all of the cancer becomes resistant at once and sometimes just parts...

Recent Comments

Hi Tammy,  Welome to Grace. …
By JanineT GRACE … on Tue, 05/16/2023 - 13:44
By Tndiuka10 on Fri, 05/12/2023 - 21:13
Hi Caregiver and welcome to…
By JanineT GRACE … on Fri, 05/12/2023 - 14:20
Hi Bob, Welcome to Grace.  I…
By JanineT GRACE … on Tue, 05/02/2023 - 12:29