First-line treatment for patients with EGFR mutation in lung cancer A patient with advanced lung adenocarcinoma achieved PR after 2 cycles of treatment with Fabitai + platinum, with no significant hematologic toxicity or gastrointestinal adverse effects, and during this treatment process, the test results came out showing that the patient has EGFR mutation. In this case, your treatment options are 1) to continue the original regimen for 4 cycles and judge the next step based on the efficacy results; 2) or discontinue the original treatment to choose targeted therapy or use targeted + chemotherapy, which is the fastest treatment mode. The experts voted: Zhang Liping, Department of Oncology, Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine More than 90% of the experts continued the original chemotherapy for 4 cycles without directly changing the treatment plan (i.e., using TKI, the fastest mode of treatment), and on this basis, we all conducted a second round of voting for all the participating experts. experts’ views? The results showed that 97% of the experts agreed or strongly agreed with the results of the top national experts, which shows that the power of our role models is very great. In other words, for patients who have achieved PR with first-line therapy, we do not need to change the treatment regimen despite the discovery of EGFR mutation during chemotherapy, but use the original chemotherapy regimen for 4-6 cycles, and then choose the next treatment regimen according to the treatment results or toxic side effects. For patients with mutations in EGFR, although the position of targeted therapy is greater than chemotherapy because of its high remission rate, long PFS and good quality of life, the position of chemotherapy should not be ignored as well. Note that the OPTIMAL study tells us that such patients can only live up to 20 months with targeted therapy alone, while patients can live up to 30 months or more with targeted therapy based on targeted therapy, that is, chemotherapy selected after the progression of targeted therapy, and this improvement in efficacy and prolongation of patient survival is not very much related to the order of targeted drugs or chemotherapy drugs, with chemotherapy first and then targeted, or first with The total survival of the two groups was exactly the same when chemotherapy was used first and then targeted, or when targeted was used first and then chemotherapy. For patients with mutations in EGFR, we need to manage the whole process, choosing either targeted or chemotherapy in the first line, and after choosing targeted in the first line, don’t forget to choose chemotherapy in the second line, the status of chemotherapy in the second line is equally important.