Key points
- Before any treatment, an EGFR test on the tumour sample is needed; both in disease that has spread and after surgery [11, 8].
- With an EGFR mutation, a targeted tablet is better than chemotherapy; without the mutation, the same tablet is worse [3].
- With osimertinib tablets, half of patients with disease that had spread lived more than 3 years [5].
- After surgery, 3 years of osimertinib lengthened life: five years on, almost 9 in every 10 people were alive [8].
The story of a mutation
In the early 2000s, advanced lung cancer was a very hard disease even with the best chemotherapy: half of patients lived less than 8 months, and after 2 years only about 1 in 10 was alive [1].
In those same years a new tablet called gefitinib was tested. Most patients did not respond, but about 1 in 10 had a fast and remarkable response. In 2004 researchers found the secret: almost all these patients had a mutation in the EGFR gene of their tumour [2].
The next large study, most of whose patients were Asian, taught an important lesson: in patients with the mutation, the tablet was far better than chemotherapy; but in patients without the mutation, the same tablet was worse than chemotherapy [3]. In other words, the right decision is impossible without the test.
Treatment today at each stage
- 1
After surgery (stages 1B to 3A)
The EGFR test should be done on the surgical sample. If there is a common mutation (exon 19 deletion or L858R), osimertinib tablets are given for up to 3 years, after chemotherapy if needed; five years on, more patients were alive than among those who did not take the tablet [8].
- 2
Stage 3 that cannot be operated on
After chemotherapy and radiotherapy together, osimertinib lengthened the time the disease was controlled from about 6 months to more than 3 years [9].
- 3
Disease that has spread
The first treatment is osimertinib tablets; they controlled the disease nearly twice as long as earlier-generation tablets and lengthened life [4, 5]. They also work in patients with tumours in the brain [10]. Adding chemotherapy, or a combination of two other targeted drugs, has lengthened life further, with more side effects [6, 7].
Which test, and on what sample?
The test is done on the same sample taken at biopsy or surgery; often a new biopsy is not needed. In advanced lung cancer, the European Society for Medical Oncology recommends broad genetic testing (NGS) so that all treatable changes (EGFR, ALK, ROS1, BRAF, MET, RET and others) are seen at once [11]. If the sample is not enough, a blood test (liquid biopsy) sometimes helps (liquid biopsy).
When should I call my doctor?
While on targeted lung cancer tablets, report a new cough, breathlessness or fever straight away (it may be lung inflammation). Diarrhoea, acne-like rash and inflammation around the nails are common and treatable; do not stop the tablet yourself (side effects of osimertinib).
Frequently asked questions
Is the EGFR mutation inherited?
No, this mutation arises in the tumour itself and is usually not passed on to children [2].
How long does the tablet continue?
What if the tablet stops working?
After a while the disease sometimes becomes resistant to the tablet. Your doctor may ask for a new test of the tumour or blood so the next option, which may be chemotherapy or newer combinations, can be chosen.
For physicians
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IPASS: in EGFR-positive disease HR for progression 0.48 in favour of gefitinib, and in EGFR-negative disease 2.85 against it [3]. FLAURA: median PFS 18.9 versus 10.2 months (HR 0.46) [4]; median OS 38.6 versus 31.8 months (HR 0.80) [5]. FLAURA2: median OS 47.5 versus 37.6 months with added platinum-pemetrexed (HR 0.77) [6]. MARIPOSA: amivantamab-lazertinib versus osimertinib, 3-year OS 60% versus 51% (HR 0.75) [7]. ADAURA: 5-year OS 88% versus 78% (HR 0.49) [8]. LAURA: median PFS 39.1 versus 5.6 months [9]. ESMO 2024: NGS in advanced non-squamous NSCLC [11]. Doses: adjuvant osimertinib · osimertinib in advanced disease.
Scientific evidence
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Scientific evidence
7 itemsOverall Survival with Osimertinib in Untreated, EGFR -Mutated Advanced NSCLC
Survival with Osimertinib plus Chemotherapy in EGFR -Mutated Advanced NSCLC
Overall Survival with Osimertinib in Resected EGFR-Mutated NSCLC
Osimertinib after Chemoradiotherapy in Stage III EGFR-Mutated NSCLC
CNS Response to Osimertinib Versus Standard Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients With Untreated EGFR -Mutated Advanced Non–Small-Cell Lung Cancer
Overall Survival with Amivantamab–Lazertinib in EGFR -Mutated Advanced NSCLC
Osimertinib in Untreated EGFR -Mutated Advanced Non–Small-Cell Lung Cancer
Read more
Related cancer types
References
11 referencesShow all references, 9 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1Comparison of Four Chemotherapy Regimens for Advanced Non–Small-Cell Lung Cancer
- 2
- 3
- 4
- 5
- 6Survival with Osimertinib plus Chemotherapy in EGFR-Mutated Advanced NSCLC
- 7Overall Survival with Amivantamab–Lazertinib in EGFR-Mutated Advanced NSCLC
- 8
- 9Osimertinib after Chemoradiotherapy in Stage III EGFR-Mutated NSCLC
- 10CNS Response to Osimertinib Versus Standard Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients With Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer
- 11
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/articles/egfr-lung-cancer-treatment/
