EGFR-Positive Lung Cancer Treatment Options

• Osimertinib (Tagrisso)
• Afatanib (Gilotrif)
• Erlotinib (Tarceva)
• Lazertinib (Lazcluze)

• Osimertinib (Tagrisso) plus chemotherapy.
• Lazertinib (Lazcluze) plus amivantamab (Rybrevant). 
  • Amivantamab is an antibody-based therapy that blocks the EGFR protein on the surface of cancer cells. 
• Erlotinib (Tarceva) plus ramucirumab (Cyramza). 
  • This combination is FDA-approved for initial treatment of patients with EGFR exon 19 deletions or exon 21 L858R mutations. Adding ramucirumab, which is an anti-angiogenic agent, may help slow resistance to EGFR-targeted therapy. 
• Amivantamab (Rybrevant) plus chemotherapy for EGFR exon 20 insertion mutations.

EGFR-positive lung cancer caught at an early stage may often be treated with surgery to remove the tumor. 

Certain patients, particularly stage III NSCLC, may receive osimertinib (Tagrisso) after surgery or chemoradiation, and some patients may receive chemotherapy exclusively. 

Treatment for later-stage EGFR-positive lung cancer depends on the type of EGFR mutation present and how the cancer progresses.

First-line treatment for EGFR exon 19 deletions or exon 21 L858R point mutations is osimertinib (Tagrisso) alone or in combination with chemotherapy or the combination of lazertinib (Lazcluze) and amivantamab-vmjw (Rybrevant) (an antibody-based therapy). 

Dacomitinib (Vizimpro) is a second-generation EGFR inhibitor approved as a first-line treatment for EGFR exon 19 deletions or exon 21 L858R mutations. It may be an option for some patients, especially those who are not eligible for newer third-generation EGFR inhibitors.

First-line treatment for EGFR S7681, L861Q or G719X mutations is afatanib (Gilotrif) or osimertinib (Tagrisso).

First-line treatment for EGFR exon 20 Insertions is chemotherapy with amivantamab (Rybrevant). 

Sunvozertinib (Zegfrovy, Dizal (Jiangsu) Pharmaceutical Co., Ltd.) is also available for EGFR exon 20 insertions, as detected by an FDA-approved test (Oncomine Dx Express Test), for individuals whose disease has progressed on or after platinum-based chemotherapy.