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
Clinical activity of afatinib in patients with advanced non-small-cell lung cancer harbouring uncommon EGFR mutations: a combined post-hoc analysis of LUX-Lung 2, LUX-Lung 3, and LUX-Lung 6.
BACKGROUND Most patients with non-small-cell lung cancer tumours that have EGFR mutations have deletion mutations in exon 19 or the Leu858Arg point mutation in exon 21 , or both ( ie , common mutations ) . However , a subset of patients ( 10 % ) with mutations in EGFR have tumours that harbour uncommon mutations . There is a paucity of data regarding the sensitivity of these tumours to EGFR inhibitors . Here we present data for the activity of afatinib in patients with advanced non-small-cell lung cancer that have tumours harbouring uncommon EGFR mutations . METHODS In this post-hoc analysis , we used prospect ively collected data from  tyrosine kinase inhibitor-naive patients with EGFR mutation-positive advanced ( stage IIIb-IV ) lung adenocarcinomas who were given afatinib in a single group phase 2 trial ( LUX-Lung 2 ) , and r and omised phase 3 trials ( LUX-Lung 3 and LUX-Lung 6 ) . Analyses were done in the intention-to-treat population , including all r and omly assigned patients with uncommon EGFR mutations . The type of EGFR mutation ( exon 19 deletion [ del19 ] , Leu858Arg point mutation in exon 21 , or other ) and ethnic origin ( LUX-Lung 3 only ; Asian vs non-Asian ) were pre-specified stratification factors in the r and omised trials . We categorised all uncommon mutations as : point mutations or duplications in exons 18 - 21 ( group 1 ) ; de-novo Thr790Met mutations in exon 20 alone or in combination with other mutations ( group 2 ) ; or exon 20 insertions ( group 3 ) . We also assessed outcomes in patients with the most frequent uncommon mutations , Gly719Xaa , Leu861Gln , and Ser768Ile , alone or in combination with other mutations . Response was established by independent radiological review . These trials are registered with Clinical Trials.gov , numbers NCT00525148 , NCT00949650 , and NCT01121393 . FINDINGS Of 600 patients given afatinib across the three trials , 75 ( 12 % ) patients had uncommon EGFR mutations ( 38 in group 1 , 14 in group 2 , 23 in group 3 ) . 27 ( 71·1 % , 95 % CI 54·1 - 84·6 ) patients in group 1 had objective responses , as did two ( 14·3 % , 1·8 - 42·8 ) in group 2 and two ( 8·7 % , 1·1 - 28·0 ) in group 3 . Median progression-free survival was 10·7 months ( 95 % CI 5·6 - 14·7 ) in group 1 , 2·9 months ( 1·2 - 8·3 ) in group 2 ; and 2·7 months ( 1·8 - 4·2 ) in group 3 . Median overall survival was 19·4 months ( 95 % CI 16·4 - 26·9 ) in group 1 , 14·9 months ( 8·1 - 24·9 ) in group 2 , and 9·2 months ( 4·1 - 14·2 ) in group 3 . For the most frequent uncommon mutations , 14 ( 77·8 % , 95 % CI 52·4 - 93·6 ) patients with Gly719Xaa had an objective response , as did nine ( 56·3 % , 29·9 - 80·2 ) with Leu861Gln , and eight ( 100·0 % , 63·1 - 100·0 ) with Ser768Ile . INTERPRETATION Afatinib was active in non-small-cell lung cancer tumours that harboured certain types of uncommon EGFR mutations , especially Gly719Xaa , Leu861Gln , and Ser768Ile , but less active in other mutations types . Clinical benefit was lower in patients with de-novo Thr790Met and exon 20 insertion mutations . These data could help inform clinical decisions for patients with non-small-cell lung cancer harbouring uncommon EGFR mutations . FUNDING Boehringer Ingelheim
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