We believe that this attempt enables clinicians to choose appropriate treatment easier .
According to rapid development of chemotherapy in advanced non-small cell lung cancer ( NSCLC ) , the Japan Lung Cancer Society has been up date d its own guideline annually since 2010 .
Recently , we have had various types of chemotherapeutic drugs like kinase inhibitors or immune-checkpoint inhibitors .
Thus , the guideline proposes to categorize patients into three entities : ( 1 ) driver oncogene-positive , ( 2 ) PD-L1 ≥ 50 % , and ( 3 ) others .
Here , we report an English version of the Japan Lung Cancer Society Guidelines 2018 for NSCLC , stages IV
Osimertinib in Untreated EGFR‐Mutated Advanced Non–Small‐Cell Lung Cancer
Background Osimertinib is an oral , third‐generation , irreversible epidermal growth factor receptor tyrosine kinase inhibitor ( EGFR‐TKI ) that selectively inhibits both EGFR‐TKI – sensitizing and EGFR T790 M resistance mutations . We compared osimertinib with st and ard EGFR‐TKIs in patients with previously untreated , EGFR mutation – positive advanced non – small‐cell lung cancer ( NSCLC ) . Methods In this double‐blind , phase 3 trial , we r and omly assigned 556 patients with previously untreated , EGFR mutation – positive ( exon 19 deletion or L858R ) advanced NSCLC in a 1:1 ratio to receive either osimertinib ( at a dose of 80 mg once daily ) or a st and ard EGFR‐TKI ( gefitinib at a dose of 250 mg once daily or erlotinib at a dose of 150 mg once daily ) . The primary end point was investigator‐assessed progression‐free survival . Results The median progression‐free survival was significantly longer with osimertinib than with st and ard EGFR‐TKIs ( 18.9 months vs. 10.2 months ; hazard ratio for disease progression or death , 0.46 ; 95 % confidence interval [ CI ] , 0.37 to 0.57 ; P<0.001 ) . The objective response rate was similar in the two groups : 80 % with osimertinib and 76 % with st and ard EGFR‐TKIs ( odds ratio , 1.27 ; 95 % CI , 0.85 to 1.90 ; P=0.24 ) . The median duration of response was 17.2 months ( 95 % CI , 13.8 to 22.0 ) with osimertinib versus 8.5 months ( 95 % CI , 7.3 to 9.8 ) with st and ard EGFR‐TKIs . Data on overall survival were immature at the interim analysis ( 25 % maturity ) . The survival rate at 18 months was 83 % ( 95 % CI , 78 to 87 ) with osimertinib and 71 % ( 95 % CI , 65 to 76 ) with st and ard EGFR‐TKIs ( hazard ratio for death , 0.63 ; 95 % CI , 0.45 to 0.88 ; P=0.007 [ nonsignificant in the interim analysis ] ) . Adverse events of grade 3 or higher were less frequent with osimertinib than with st and ard EGFR‐TKIs ( 34 % vs. 45 % ) . Conclusions Osimertinib showed efficacy superior to that of st and ard EGFR‐TKIs in the first‐line treatment of EGFR mutation – positive advanced NSCLC , with a similar safety profile and lower rates of serious adverse events . ( Funded by AstraZeneca ; FLAURA Clinical Trials.gov number , NCT02296125 .
We believe that this attempt enables clinicians to choose appropriate treatment easier .
According to rapid development of chemotherapy in advanced non-small cell lung cancer ( NSCLC ) , the Japan Lung Cancer Society has been up date d its own guideline annually since 2010 .
Recently , we have had various types of chemotherapeutic drugs like kinase inhibitors or immune-checkpoint inhibitors .
Thus , the guideline proposes to categorize patients into three entities : ( 1 ) driver oncogene-positive , ( 2 ) PD-L1 ≥ 50 % , and ( 3 ) others .
Here , we report an English version of the Japan Lung Cancer Society Guidelines 2018 for NSCLC , stages IV