One of the coordinators of this project was Dr. Dolores Isla, head of the Medical Oncology Service at the Lozano Blesa University Clinical Hospital (Zaragoza), who explains the main keys to consensus. I also spoke with Dr. Javier de Castro, President of ICAPEM.
Question. Why did you think it was necessary to develop this consensus on the diagnosis and treatment of patients with EGFR mutant NSCLC?
Answer. Dolores Island. Our main goal was to optimize the diagnostic and therapeutic strategy of these patients in Spain and to help make decisions in clinical practice. At present, clinical guidelines do not always take into account all possible clinical situations, so a position of Spanish lung cancer experts in the face of poorly established scientific evidence on diagnostic issues, clinical characteristics of patients, and the first choice and two treatment line and successive, is of great interest.
Why did ICAPEM want to promote the creation of this consensus?
Javier de Castro. From the association we promote research on biological and environmental characteristics that cause gender differences in lung cancer. NSCLC with EGFR mutations preferentially affects women. For this reason, from ICAPEM we wanted to perform a review analysis to serve as an update of the clinical guidelines. In recent years, valuable therapeutic innovations have been introduced for patients and we wanted to make it easier for them to access them.
How was this consensus drawn up?
DI A scientific committee was formed, consisting of six medical oncologists specializing in lung cancer, including the coordinators, Dr. Óscar Juan-Vidal, associate physician of the Medical Oncology Service of La Fe University Hospital (Valencia) and myself. Within the Committee, we established 33 statements about the diagnosis and treatment of this pathology. After selecting a group of experts from 31 oncologists specialized in the field, these statements were evaluated, assessing their degree of agreement or disagreement. The truth is that the degree of consensus has been very high.
What are the most relevant conclusions of this document?
DI. Regarding the treatment of patients with advanced NSCLC and carriers of the EGFR mutation, there was a high degree of consensus regarding osimertinib as the best first-line treatment option in patients with frequent activation mutations due to the safety profile and progression-free survival and overall survival compared to other first- and second-generation TKI-EGFRs.
Regarding the diagnosis, perhaps the most important conclusion was the need to know the state of the EGFR mutation, regardless of the stage of the disease and the inclusion of liquid biopsy as an effective alternative to molecular diagnosis when tissue biopsy fails. There was also a high consensus on the importance of the image of the central nervous system at the time of diagnosis.
Why is it so important to make a molecular diagnosis in lung cancer?
The C Knowing the status of the EGFR mutation in these types of patients, as well as performing a biomarker analysis, is essential to determine the treatment strategy. The discovery of the EGFR gene was one of the most important advances in lung cancer, as it allows us to apply therapies that act directly on this mutation, managing to extend the patient’s response from month to year, with a clear benefit in survival. It is truly a model of personalized medicine and precision therapy.
In fact, advances in diagnosis are very relevant, as the latest innovations in NSCLC have taken place in the area of targeted therapies. It is vitally important that a thorough review of biomarkers be performed at any stage of the disease, in order to apply the appropriate therapeutic strategy for each type of patient in each case. It is exciting to see the degree of personalization that medical oncology has in recent years and it is imperative to know how to incorporate it.
According to this consensus, what would be the recommendation in case of disease progression?
DI According to the consensus reached, in case of oligoprogression under first line treatment with osimertinib, it is recommended to maintain this treatment and add another site until the disease progresses or unacceptable toxicity, as mentioned in the data sheet.
In case of disease progression, a new biopsy would be recommended and the priority will be to include the patient in a clinical study.
How many patients are affected by lung cancer?
The C It is the most common tumor in the world. In Spain it is the fourth most common, accounting for 10% of all cancers. In addition, it is the one that produces the highest mortality: 20% of all cancers in Spain. Specifically, NSCLC represents between 85% and 90% of all cases of lung cancer, adenocarcinoma being the most common subtype. In our context, EGFR mutations are found in approximately 10-12% of patients with adenocarcinoma. Although we know that this type of mutation is more common in non-smokers, women and Asians, it is important to note that it can be present in any patient with this disease, which requires an appropriate biomarker study in all patients.
What do you hope to achieve with this consensus?
The C We hope that it will become a tool that can help Spanish oncologists improve treatment strategies for small cell lung cancer and, above all, raise awareness of the importance of molecular diagnosis to optimize treatments. All this would mean an improvement in the quality and life expectancy of patients.
DI Healthcare professionals need to be informed and careful about the latest developments in order to provide patients with the treatments that best suit their situation. We have tools that will allow us to extend the lives of patients with an improvement in their quality of life. As the coordinator of this consensus, I am pleased that we have been able to contribute to decision-making support in the care of these patients.
By 2040, 40,000 new cases of lung cancer are expected to appear, of which about 25% will be in women.
The C In recent years, a notable increase has been detected in lung cancer in women. One of these most worrying increases is in the case of young women. There are biological and clinical differences in lung cancer between men and women and much remains to be investigated in this regard.
At ICAPEM we have been working for ten years to make these needs visible and we are very proud that we can carry out initiatives like this with the collaboration of a leading oncology laboratory, such as AstraZeneca.