Here is a helpful review on the rapidly evolving data on the optimal use of adjuvant EGFR-targeted agents for resected stage IB-IIIA non-small cell lung cancer. A big question mark remaining despite multiple phase 3 trials establishing the efficiency of these therapies is what, if anything, is achieved with the addition of chemo to the mix. Retrospective data suggests patients with EGFR-mutant NSCLC (1) do not appreciably benefit from adjuvant chemo and (2) achieve the same DFS benefit with EGFR-targeted agents on trial whether or not chemo was also received per physician discretion. Importantly, despite promising disease-free survival outcomes at 2 years, the majority of patients with EGFR-mutant NSCLC will eventually recur, most commonly locally. While tissue attainment via biopsy or ctDNA upon relapse can be helpful to elucidate mechanisms of resistance, typically a rechallenge with a third-gen EGFR-targeted agent is effective. | Passaro, JAMA Oncol 2023
