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. 2025 Oct 15;157(8):1648-1661.
doi: 10.1002/ijc.35512. Epub 2025 Jun 14.

Optimizing management of stage IV EGFR mutant non-small cell lung cancer in Asia: An expert opinion

Gee-Chen Chang  1   2   3 , Akhil Kapoor  4 , Chee Khoon Lee  5 , Chunxia Su  6 , Daniel Chan  7 , Guia Elena Imelda Ladrera  8 , Hye Ryun Kim  9 , Mostafa Aziz Sumon  10 , Moushumi Suryavanshi  11 , Sita Andarini  12 , Tatsuya Yoshida  13 , Thanyanan Reungwetwattana  14 , Tuan Khoi Nguyen  15 , Pei Jye Voon  16
Affiliations

Optimizing management of stage IV EGFR mutant non-small cell lung cancer in Asia: An expert opinion

Gee-Chen Chang et al. Int J Cancer. .

Abstract

Lung cancer is Asia's most prevalent cancer, accounting for the highest global patient share. A significant number of non-small cell lung cancer (NSCLC) patients in Asia exhibit mutations in the epidermal growth factor receptor (EGFR). Although clinical outcomes are improving with newer therapies, challenges persist in the effective management of EGFR mutant (EGFRm) NSCLC. Given the substantial disease burden, understanding the current diagnostic and treatment patterns for EGFRm NSCLC from an Asian perspective is essential. This expert opinion presents recommendations from Asian experts on molecular testing and treatment of first-line and second-line EGFRm NSCLC. The recommendations aim to optimize patient outcomes by providing a comprehensive approach to diagnosis and management, considering the high prevalence of EGFR mutations in the Asian population. The experts discussed and recommended approaches for optimal management of EGFRm NSCLC. Next-generation sequencing (NGS) testing is recommended to be included in the reimbursement scheme, and the turnaround time of testing should be shortened, considering the high burden of the disease in Asia. The panel recommended careful selection of patients for osimertinib+chemotherapy or lazertinib+amivantamab based on safety and efficacy profile, patient age, and disease status. While the panel agreed that osimertinib+chemotherapy is acceptable for these patients, dose adjustment and careful patient selection are recommended to optimize safety outcomes. For lazertinib+amivantamab, measures to mitigate adverse events such as the use of pre-medication with steroids, prophylactic anticoagulants, and dose modification are recommended. For patients progressing on one of the combination regimens, experts recommended repeat NGS testing and continued treatment with chemotherapy.

Keywords: Asian exert opinion; EGFR positive NSCLC; EGFRm NSCLC; NSCLC in Asia.

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Conflict of interest statement

Gee‐Chen Chang has received honoraria from AstraZeneca, Merck Sharp and Dohme, Novartis, Boehringer Ingelheim, Hoffman‐La Roche, Eli Lilly, Pfizer, and Bristol‐Myers Squibb. Akhil Kapoor has served as an investigator on multiple clinical trials for AstraZeneca, Bayer, Bristol Myers Squibb, Eli Lilly, Erixis, MSD, and Novartis. All grants in this regard were paid to the institution. Chee Khoon Lee has received honoraria and grants from AstraZeneca, Amgen, Janssen, GSK, Boehringer Ingelheim, MSD, Roche, Gilead, Novartis, and Glenmark, and meeting/travel support from AstraZeneca and Janssen. Chunxia Su declares no conflict of interest for this study. Daniel Chan and Moushumi Suryavanshi have received consulting fees from AstraZeneca. Guia Elena Imelda Ladrera has served on the advisory board and received honoraria and travel expenses from AstraZeneca. Hye Ryun Kim received honoraria from AstraZeneca, Bristol Myers Squibb, Genentech/Roche, stock ownership in Bridgebio Therapeutics; served in a consultation or advisory role for Bayer, AstraZeneca, Bristol Myers Squibb, Takeda, and Yuhan; and received research funding from the Yonsei Lee Youn Jae Fellowship outside of the current study. Mostafa Aziz Sumon reports no conflict of interest. Sita Andarini has received honoraria from AstraZeneca, Darya Varia, Etana, GOF, Hetero, JNJ, Kalgen Innolab, MSD, Pfizer, Roche, Takeda, ZuelligPharma Therapeutics, travel grants from AstraZeneca, Darya Varia, Etana, GOF, Hetero, JNJ, Kalgen Innolab, MSD, Pfizer, Roche, Takeda, ZuelligPharma Therapeutics, and has served on advisory boards for AstraZeneca, Darya Varia, JNJ, MSD. Tatsuya Yoshida has received grants from Novartis, AbbVie, Amgen, Daiichi‐Sankyo, AstraZeneca, MSD, Chugai Pharmaceutical Co. Ltd, Astellas, Boehringer Ingelheim, BMS, Ono Pharmaceutical, and Merck Biopharma, honoraria from Novartis, Daiichi‐Sankyo, AstraZeneca, MSD, Chugai Pharmaceutical Co. Ltd, BMS, Ono, Takeda, Pfizer, Lilly, and Merck Biopharma, and has been a member of the advisory board for Novartis, MSD, Amgen, Chugai Pharmaceutical Co. Ltd, Pfizer, and Boehringer Ingelheim. Thanyanan Reungwetwattana received honoraria from AstraZeneca, Roche, BMS, J&J, Pfizer, Amgen, Takeda, MSD; served on advisory board for AstraZeneca, Roche, BMS, J&J, Pfizer, Amgen, Takeda, Yuhan, MSD; and a grant for clinical research was paid to the institution by AstraZeneca, Roche, MSD, Yuhan. Tuan Khoi Nguyen has received grants from MSD, Roche, and AstraZeneca; honoraria, travel support, and consulting fees from MSD, Roche, AstraZeneca, Novartis, Pfizer, and Pierre Fabre. Pei Jye Voon has received grants/contracts from Astra Zeneca, Novartis, Boehringer Ingelheim, Janssen‐Cilag, Johnson & Johnson, Viracta Therapeutics Inc., ROCHE, Merck KGaA, Merck Sharp & Dohme, Beigene, Amgen, Revolutionary Medicine; consulting fees from Astra Zeneca, Novartis, Merck Sharp & Dohme, Pfizer, Beigene, Amgen, Merck KGaA, Janssen‐Cilag, Johnson & Johnson; and honoraria payments from Astra Zeneca, Novartis, Merck Sharp & Dohme, Pfizer, Amgen, Merck KGaA, Janssen‐Cilag, Johnson & Johnson.

Figures

FIGURE 1
FIGURE 1
Preference for NGS testing among participating experts. (A) Pre‐meeting survey: Frequency of EGFR testing. (B) Voting: Preference for NGS testing. EGFR, Epidermal growth factor receptor; NGS, Next generation sequencing; NSCLC, Non‐small cell lung cancer.
FIGURE 2
FIGURE 2
Patient selection criteria for first line therapy. (A) Pre‐meeting survey: Implications of using Osimertinib + chemotherapy regimen in clinical practice. (B) Pre‐meeting survey: Implications of using Lazertinib + amivantamab regimen in clinical practice. (C) Pre‐meeting survey: Differentiating factor between Osimertinib + chemotherapy and Lazertinib + amivantamab regimens. (D) Voting: Preference for consultation regarding combination regimens. (E) Voting: Patient selection for Osimertinib + chemotherapy and Lazertinib + amivantamab regimens. (F) Voting: Preferred therapy based on available evidence. CNS, Central nervous system; EGFR, Epidermal growth factor receptor; NSCLC, Non‐small cell lung cancer.
FIGURE 3
FIGURE 3
Pre‐meeting survey: Confidence in management of toxicities.
FIGURE 4
FIGURE 4
Opinion on tissue rebiopsy post progression on first‐line osimertinib. (A) pre‐meeting survey. (B) voting. EGFR, Epidermal growth factor receptor; NGS, Next generation sequencing; NSCLC, Non‐small cell lung cancer; 1L, First‐line treatment; 1st line, First‐line treatment.
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