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Table of Contents
LETTER TO EDITOR
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 248-249

Sailing through lung cancer charted by EGFR signposts


1 Department of Medical Oncology, Aster MIMS, Kannur, Kerala, India
2 Department of Pulmonology, Aster MIMS, Kannur, Kerala, India

Date of Web Publication20-Dec-2019

Correspondence Address:
Sujith Kumar Mullapally
Department of Medical Oncology, Aster MIMS, Kannur, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_69_19

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How to cite this article:
Mullapally SK, Revendran J. Sailing through lung cancer charted by EGFR signposts. Cancer Res Stat Treat 2019;2:248-9

How to cite this URL:
Mullapally SK, Revendran J. Sailing through lung cancer charted by EGFR signposts. Cancer Res Stat Treat [serial online] 2019 [cited 2020 Apr 3];2:248-9. Available from: http://www.crstonline.com/text.asp?2019/2/2/248/273684



The review article on the epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) has been read with great interest by us from the oncology and pulmonology community.[1] With such fast advancements happening in the field of oncology, it is extremely difficult to keep up with the pace in real time. In this context, the authors have been very meticulous in describing the topic in its full magnitude from the description on the EGFR pathway, relevant drug-related information, the important trials, and the latest developments. It is of great use to the residents in oncology, pulmonology, and also the practicing clinicians.

However, we wish to add few issues not addressed in the review article. The differences between the efficacy of erlotinib and gefitinib have not been discussed well. As the most common tyrosine kinase inhibitors (TKIs) used in low and middle income countries, a comparison between both of them will be useful. For example, there are few studies which show that erlotinib is more effective than gefitinib in patients with exon 19 EGFR-mutant lung adenocarcinoma and brain metastases.[2] Furthermore, in the section about the baseline resistance to TKI, the impact of smoking status also could have been discussed. It has been seen in multiple studies that never-smokers appear to show longer overall survival and progression-free survival as compared to former or current smokers. The response rate was very low in heavy smokers (>30 pack-years) when compared to non-smokers.[3] Furthermore, in the section of central nervous system penetration of TKIs, there needs to be mention about stereotactic radiosurgery (SRS). The current standard of care is SRS with or without whole-brain radiotherapy (WBRT). Especially in EGFR-mutated NSCLC, where the patients will have long-term survival with TKI, SRS will be preferable over WBRT in view of the cognitive decline seen after WBRT.[4]

The authors deserve full credit for preparing an excellent review which touches most of the aspects of clinical management of EGFR-mutated non-small cell carcinoma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rajendra A, Noronha V, Joshi A, Patil VM, Menon N, Prabhash K. Epidermal growth factor receptor-mutated non-small-cell lung cancer: A primer on contemporary management. Cancer Res Stat Treat 2019;2:36-53.  Back to cited text no. 1
  [Full text]  
2.
Jiang Y, Zhang J, Huang J, Xu B, Li N, Cao L, et al. Erlotinib versus gefitinib for brain metastases in Asian patients with exon 19 EGFR-mutant lung adenocarcinoma: A retrospective, multicenter study. BMC Pulm Med 2018;18:171.  Back to cited text no. 2
    
3.
Sohn HS, Kwon JW, Shin S, Kim HS, Kim H. Effect of smoking status on progression-free and overall survival in non-small cell lung cancer patients receiving erlotinib or gefitinib: A meta-analysis. J Clin Pharm Ther 2015;40:661-71.  Back to cited text no. 3
    
4.
Du XJ, Pan SM, Lai SZ, Xu XN, Deng ML, Wang XH, et al. Upfront cranial radiotherapy vs. EGFR tyrosine kinase inhibitors alone for the treatment of brain metastases from non-small-cell lung cancer: A meta-analysis of 1465 patients. Front Oncol 2018;8:603.  Back to cited text no. 4
    



This article has been cited by
1 Author Reply to: Sahoo, Batra et al. and Mullapally et al.
Akhil Rajendra,Vanita Noronha,Amit Joshi,VijayMaruti Patil,Nandini Menon,Kumar Prabhash
Cancer Research, Statistics, and Treatment. 2019; 2(2): 252
[Pubmed] | [DOI]



 

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