Cortellini A, Buttitta F, Marchetti A and Ficorella C
After the advent of third generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), oncologists are called to face new challenges in everyday management of EGFR mutated non-small-cell-lungcancer (NSCLC) patients. These drugs, in particular Osimertinib (which is the only one currently available), represent an extraordinary innovation. But while raising the bar of expectations, they pose us new challenges. Mechanisms of resistance to Osimertinib are heterogeneous: from a "molecular point of view" they can be categorized in EGFR-dependent and independent ones. In recent years many clinical reports have shown interesting results with target treatments, mainly chosen on the basis of the "molecular resistance". However, in common practice clinicians and patients must face off with the reality and with limited treatment options. It may be helpful to classify different clinical patterns of disease progression during treatment with Osimertinib. Treating a localized progression to a single organ certainly differs from treating a wide dissemination of disease, as well as treating symptomatic progressions differs from treating non-symptomatic ones. This mini-review aims to analyse, with a very practical approach, current options for clinical management of EGFR mutant NSCLC patient at the time of disease progression during Osimertinib, by focusing particularly on maintenance strategies beyond progression.
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