One of the coordinators of this project was Dr. Dolores Isla, Head of the Medical Oncology Service at Lozano Blesa University Clinical Hospital (Zaragoza), who explains the main keys to the consensus. We also spoke with Dr. Javier de Castro, President of ICAPEM.
Ask. Why did you think it was necessary to develop this consensus on the diagnosis and treatment of patients with EGFR-mutated NSCLC?
Answer. Dolores Island. Our main goal was to optimize the diagnostic and therapeutic strategy of these patients in Spain and to assist in decision-making in clinical practice. Currently, clinical guidelines do not always take into account all possible clinical situations, thus a position of Spanish lung cancer experts in the light of little established scientific evidence on aspects related to the diagnosis, the clinical characteristics of the patients, as well as the selection of the first and second line of treatment and subsequent treatment is of great importance.
Why did ICAPEM want to promote the creation of this consensus?
Javier de Castro. At the association, we promote research into the biological and environmental characteristics that cause gender differences in lung cancer. NSCLC with EGFR mutations preferentially affects women. For this reason, we wanted to perform a review analysis from ICAPEM that would serve as an update of the clinical guidelines. In recent years, therapeutic innovations of great value to patients have been introduced and we wanted to facilitate their access to these innovations.
How did this consensus come about?
DI A Scientific Committee was established consisting of six medical oncologists who are experts in lung cancer, including coordinators, Dr. Óscar Juan-Vidal, Deputy Physician of the Medical Oncology Service of the University Hospital La Fe (Valencia), and myself. We made 33 judgments from the committee about the diagnosis and treatment of this pathology. After selecting a panel of experts from 31 oncologists who also specialized in the field, these statements were evaluated, assessing their agreement or disagreement. The truth is, the degree of consensus was very high.
What are the most relevant conclusions of this document?
DI. Regarding the treatment of patients with advanced NSCLC and carriers of the EGFR mutation, there was a high degree of consensus on osimertinib as the best first-line treatment option in patients with common activating mutations due to its safety profile and progression-free survival and survival compared to other TKIs. First and second generation EGFRs.
In terms of diagnosis, perhaps the most important conclusion was the need to know EGFR mutation status regardless of the stage of the disease and the inclusion of liquid biopsy as an effective molecular diagnostic alternative when tissue biopsy fails. There was also a great consensus on the importance of central nervous system imaging at the time of diagnosis.
Why is it so important to make a molecular diagnosis of lung cancer?
JC Knowing the status of the EGFR mutation in these types of patients, as well as performing a biomarker analysis, is essential to determine the treatment strategy. The discovery of the EGFR gene was one of the most significant advancements in lung cancer as it allows us to apply therapies that act directly on this mutation, extending the patient’s response from months to years, with clear benefit in survival. It is truly a model of personalized medicine and precision therapy.
Advances in diagnostics are actually quite relevant, as the most recent innovations in NSCLC have been in the field of targeted therapies. It is vital that a thorough evaluation of the biomarkers is carried out at every stage of the disease in order to apply the correct therapeutic strategy for each patient type. It’s exciting to see the level of personalization that medical oncology is going through in recent years and it is imperative that we know how to integrate it.
According to this consensus, what would be the recommendation in case of disease progression?
DI According to the consensus reached, in the case of oligoprogression on osimertinib treatment in primary care, it is recommended to continue this treatment and add another site until disease progression or unacceptable toxicity, as stated in the technical data sheet.
In the event of disease progression, it would be recommended to perform a new biopsy and the priority will be to include the patient in a clinical trial.
How many patients have lung cancer?
JC It is the most common tumor in the world. In Spain it is the fourth most common, accounting for 10% of all cancers. Moreover, it is the one that causes the highest mortality: 20% of all cancers in Spain. Specifically, NSCLC represents between 85% and 90% of all lung cancers, with adenocarcinoma being the most common subtype. In our setting, EGFR mutations are found in approximately 10-12% of patients with adenocarcinoma. While we know that this type of mutation is more common in non-smokers, women, and Asians, it is important to note that it can be present in any patient with this disease, requiring an adequate biomarker study in all patients.
What do you hope to achieve with this consensus?
JC We hope it will become a resource that can help Spanish oncologists improve treatment strategies for non-small cell lung cancer and, above all, raise awareness of the importance of molecular diagnosis in optimizing treatments. All of this would improve the quality and life expectancy of patients.
DI Health professionals need to be informed and ensure they are aware of the latest developments to provide patients with the treatments best suited to their situation. We have tools that allow us to extend patients’ lives while improving their quality of life. As coordinator of this consensus, I am delighted to have been able to contribute to decision-making support for these patients.
It is expected that by 2040 there will be 40,000 new cases of lung cancer, of which about 25% in women.
JC In recent years, a remarkable increase has been noted in lung cancer cases in women. One of these most worrisome rises is in young women. There are biological and clinical differences in lung cancer between men and women and much remains to be explored on this point.
At ICAPEM we have been working to bring these needs to light for a decade and we are very proud to be able to implement initiatives such as these and with the collaboration of a leading oncology laboratory such as AstraZeneca.