First-line use of EGFR tyrosine kinase inhibitors in patients with NSCLC containing EGFR mutations.

While the small molecule epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors erlotinib and gefitinib have modest clinical benefit in unselected patients with non-small cell lung cancer after platinum-based chemotherapy, an emerging and potentially more elegant strategy is to move these agents to the frontline setting for select patients. Those with somatic mutations in EGFR respond dramatically to EGFR inhibitors, and mounting evidence from recent clinical trials, particularly the Iressa Pan-Asia Study (IPASS) trial, confirms superior response rates, progression-free survival, and tolerability with this targeted therapy compared with conventional chemotherapy. Here, we review the studies supporting the use of EGFR tyrosine kinase inhibitors in the frontline setting in patients with EGFR mutations.