What You Need to Know About Lung Cancer and EGFR Mutations

This article is for people who have newly diagnosed EGFR-mutated lung cancer, or their care partner, and others who want to learn more about available treatment options. The goal is to help patients with newly diagnosed EGFR-mutated non-small-cell lung carcinoma (NSCLC) and their care partners better understand the treatment options available.

You’ll explore:

• What EGFR-mutated non-small cell lung cancer (NSCLC) is

• How treatment for EGFR-mutated NSCLC is different from other lung cancer treatments

• What treatment options are available, as well as their risks and benefits

• How treatment may impact your prognosis (chance of a cure)

• The importance of sharing your treatment goals, preferences, and bepefs with your cancer care team

• Questions you can ask your provider about EGFR-mutated NSCLC and treatment

When you are diagnosed with non-small cell lung cancer (NSCLC), your doctor will order a test to see if your cancer cells have an epidermal growth factor receptor (EGFR) mutation (a specific change in the DNA) of the cancer cells). EGFR is a protein that's part of healthy cells. EGFR-mutated lung cancer means there's been a change (mutation) to the EGFR protein -- and this mutation makes cancer cells grow.

In the past, doctors thought that all lung cancers were pretty much the same. They were usually treated with chemotherapy (chemo) or radiation therapy. Today, doctors can identify several different types of cancer in the lungs. Specific medicines have been developed to treat specific cancers. These are called targeted therapies. The most progress with using targeted therapies has been treating cancer that has EGFR mutations.

Treatments like chemotherapy can't tell the difference between normal cells and cancer cells, so it attacks both. But targeted therapy mostly goes after cancer cells, so it's less likely to harm normal cells than chemotherapy, which means you may have fewer side effects.

Once your doctor knows the EGFR mutation is there, you may start to feel more in control of your health when you can begin treatment. Your doctor will recommend a medicine that stops or slows the growth of your cancer by "turning off" the EGFR mutation.

There are now 5 EGFR-targeted medicines to treat NSCLC:

• Afatinib (Gilotrif ^® )

• Dacomitinib (Vizimpro^®)

• Erlotinib (Tarceva^®)

• Gefitinib (Iressa^®)

• Osimertinib (Tagrisso^®)

If your cancer has EGFR mutations, targeted therapy may be the best option for you. Together, you and your healthcare team will decide which treatment, or combination of treatments, is best for you.

These medicines may be the best treatment for advanced EGFR-mutated lung cancer because:

• They attack the EGFR mutation in your cancer cells

• They usually don’t harm healthy cells, which means that side effects could be mild

• Standard treatment is 1 pill a day, so the treatment won't keep you from going about your usual activities

A benefit of EGFR-targeted medicines is that they give you more time before the cancer starts to grow again, as compared with other treatments. They can shrink the tumor for a few months or even stop the growth altogether.

Two of the most common side effects of EGFR-targeted medicine are rash and diarrhea. These and other side effects may range from mild to severe. Tell your healthcare team about any changes in your health so they can help you feel better.

When you start taking the medicine, talk to your team about:

• What side effects you can expect and how you can manage them

• Which side effects you need to call the office about between office visits

• How you can take care of your health to prevent or reduce side effects

Your doctor may prescribe any of the EGFR-targeted medicines as a first treatment for you. These medicines may control your disease for many months or more. When you need more treatment, your doctor may continue with your EGFR-targeted medicine or start you on a different targeted medicine.

Unfortunately, EGFR-targeted medicines may stop working. Sometimes it's because the cancer cells develop a new EGFR gene change called "T790M."  Your doctor will order another test to see if you have this change. If you do, you may be prescribed a medicine called osimertinib, which targets the T790M gene.

There are more treatment options for EGFR-mutations today than ever before. Taking on an active role with your healthcare team is important. They can help you sort through your options and make the right choices. It's important to work with your team to make informed decisions.

The relationship you have with your healthcare team can make a big difference in how you deal with the challenges of cancer treatment. Research shows that people who have good communication with their healthcare team are more satisfied with their medical care than those who do not. They also feel better emotionally and better prepared to manage symptoms like treatment side effects.

Here are some questions you can ask your cancer care team:

• What are my treatment choices when it comes to targeted therapy?

• Which treatments do you recommend and why?

• What are the goals of my treatment?

• How long will I be on this treatment?

• What happens if I miss a dose of my medicine?

• How will you know my treatment is working?

• Are there other options for me if my treatment stops working?

• What are the side effects of targeted therapy for my mutation?

• How will this treatment affect my job, my family life, and my day-to-day activities?

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