Use of the Epidermal Growth Factor Receptor Inhibitors Gefitinib (Iressa®), Erlotinib (Tarceva®), Afatinib, Dacomitinib or Icotinib in the Treatment of Non–SmallCell Lung Cancer: A Clinical Practice Guideline

Patient Population

Adult patients with advanced (stage IIIB or IV) non– small-cell lung cancer.

Intended Guideline Users

Clinicians involved in the delivery of systemic treatment for cancer patients.

Research Question(s)

1. In patients with advanced non–small-cell lung cancer (NSCLC) who have not received any chemotherapy (chemo-naive), is first-line therapy with the epidermal growth factor receptor (EGFR) inhibitors gefitinib (Iressa®), erlotinib (Tarceva®), afatinib, dacomitinib or icotinib superior to platinum-based chemotherapy for clinical meaningful outcomes (overall survival, progression-free survival (PFS), response rate and quality of life)?
2. In patients with advanced NSCLC who have progressed on platinum-based chemotherapy, does subsequent therapy with EGFR inhibitors gefitinib (Iressa®), erlotinib (Tarceva®), afatinib, dacomitinib or icotinib improve overall survival or PFS? Is there a preferred sequence for second-line therapy with an EGFR inhibitor or chemotherapy?
3. In patients with advanced stage IIIB or IV NSCLC who have received initial first-line platinum-based chemotherapy, does maintenance therapy with erlotinib, gefitinib, afatinib, dacomitinib or icotinib improve overall survival or PFS?
4. What are the toxicities associated with gefitinib (Iressa®), erlotinib (Tarceva®), afatinib, dacomitinib or icotinib?