OPTIMAL SEQUENCE OF APPLICATION OF EPIDERMAL GROWTH FACTOR RECEPTOR INHIBITORS IN ADVANCED NON-SMALL CELL LUNG CANCER PATIENTS WITH ACTIVATING EGFR MUTATIONS

Background. Successful treatment of patients with EG FR-positive non-small cell lung cancer (NSCLC ) is directly related to epidermal growth factor receptor (EG FR) tyrosine kinase inhibitors (TKIs). Currently, three generations of EG FR TKIs are used for treatment of EG FR-positive NSCLC . The issue of what drug or what sequence of its administration will be the optimal treatment option for a particular patient seems relevant. Purpose : To analyze available data on the use of TKIs for the treatment of advanced EG FR-positive NSCLC patients, as well as to assess the possible mechanisms of resistance to them and determine the optimal sequence of EG FR TKI therapy. Material and Methods . The review includes data from randomized controlled trials, as well as data from real-world studies on the efficacy of EG FR TKIs and subsequent therapy options in cases of drug resistance. Results . The choice of the optimal first-line treatment option for patients with EG FR-positive NSCLC depends on many factors. To our opinion, afatinib therapy with subsequent osimertinib therapy allows maximal prolongation of low-toxic targeted therapy and delayed administration of cytostatic drugs in patients with T790M mutation. Conclusion . Considering the dominant mechanism of resistance development (presence of EG FR -T790M mutation), the use of the second- and third-generation EG FR inhibitors seems to be an optimal treatment option for patients with activating EG FR mutations.