EGFR-TKI combination treatment for NSCLC with EGFR-sensitive mutation.

Introduction: Lung cancer is the leading cause of cancer-related deaths. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have opened up a new therapeutic avenue for EGFR-sensitive mutated non-small cell lung cancer (NSCLC), but their resistance is unavoidable. Overcoming the resistance is desperately desired. Combined treatments are partially efficient to address EGFR-TKIs resistance.

Areas covered: Combination therapies function through various mechanisms, prevent the enrichment of resistant clones, synergistically enhance efficacy, and delay the onset of resistance. This article reviews the current research of combination therapy based on EGFR-TKIs for EGFR-mutated NSCLC to identify the most effective and least harmful combined regimen. A search of the literature on PubMed, Web of Science, and Embase databases was performed without filters.

Expert opinion: The optimal treatment for EGFR-mutated NSCLC is still an open issue. EGFR-TKIs combined with anti-angiogenic drugs can bring short-term efficacy, but not benefit long-term survival and instead increase adverse reactions (AEs). The short-term efficacy of EGFR-TKIs combined with chemotherapy is clear, but the long-term efficacy varies in different studies, with significant benefits in certain subgroups. EGFR-TKIs combined with immune checkpoint inhibitors (ICIs) show a trend toward efficacy benefit, however, their high AEs requires further optimization of the combination regimen.