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Treatment Sequencing in EGFRM+ NSCLC

Boehringer Ingelheim understand that continuing clinical research is needed to give better patient outcomes.  Please see below to discover more about TKI sequencing and the video we have developed to illustrate the ever evolving landscape for treatment of EGFRM+ NSCLC.

Activating mutations in the epidermal growth factor receptor (EGFR) are known to be a driver of non-small cell lung carcinoma (NSCLC), and tyrosine kinase inhibitors (TKIs) that target these mutations are currently standard of care for first-line therapy in patients with EGFR mutation positive (EGFRM+) NSCLC. However, many patients with EGFRM+ disease eventually develop acquired resistance to these therapies, which most commonly occurs via T790M mutation.1 The clinical development of 3rd generation TKIs provides additional treatment options for these patients and can extend the chemotherapy-free interval. For clinicians seeking to further improve patient outcomes, this progress in clinical development raises questions about the optimal sequence of EGFR TKI therapies.

Possible treatment sequences with EGFR TKIs in EGFRM+ NSCLC

Treatment sequences in EGFR mutation-positive NSCLC

Figure is only for illustrative purposes and not to scale

Two recent reviews discuss the sequential use of available EGFR TKIs and key considerations when assessing the optimal sequential therapy.2,3 In his review in Future Oncology, Prof. Nicolas Girard considers how selection of the optimal first-line treatment depends on patient factors such as the presence/absence of brain metastases, resistance mechanisms, subsequent therapy options for long-term treatment and the tolerability profile of the overall treatment sequence.2 Read the Girard review here and the Hirsh review here. Additional data are also required to further inform this important clinical topic.

Prof. Nicolas Girard discusses treatment sequencing with EGFR TKIs in EGFRM+ NSCLC

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TKI sequencing in EGFRM+ NSCLC and insights from afatinib studies

Afatinib* is an irreversible ErbB Family blocker that selectively, potently and irreversibly binds to and blocks EGFR4,5.  The video below shows how the landscape for treatment for EGFRM+ NSCLC has evolved, and how insights from afatinib* studies can inform treatment sequencing for patients with EGFRM+ NSCLC.

Sequencing: The bigger picture

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To find out more about available clinical data on afatinib and treatment sequencing, please visit the afatinib clinical trial data and the NSCLC additional analyses and further trials pages. Additionally, GioTag, a real-world study of treatment sequencing in EGFRM+ NSCLC has recently been initiated.6




Novello S, et al. Ann Oncol 2016;27(suppl 5):v1–27.


Girard N. Future Oncol 2018; doi: 10.2217/fon-2017-0636 [Epub ahead of print].


Hirsh V. Ther Adv Med Oncol 2018; doi: 10.1177/1758834017753338 [Epub ahead of print].


Reid A, et al. Eur J Cancer 2007;43(3):481-9.


Li D, et al. Oncogene 2008;27(34):4702-11.


Boehringer Ingelheim. Press release. Available at: (Accessed: December 2017).

*Afatinib is approved in more than 80 markets including the EU, Japan, Taiwan, and Canada under the brand name GIOTRIF®, in the US under the brand name GILOTRIF® and in India under the brand name Xovoltib®; for the full list please see here. Registration conditions differ internationally; please refer to locally approved prescribing information.