Consensus on the lung cancer management after third-generation EGFR-TKI resistance

Abstract

Lung cancer is the most prevalent malignant tumour in the Asia–Pacific region. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancers. Among these, the rate of EGFR mutations in Asian patients with lung adenocarcinoma is 40–60%. Third-generation EGFR tyrosine kinase inhibitors (EGFR-TKIs) have improved the clinical management of NSCLC with EGFR mutations, but resistance to these drugs remains a significant challenge. Despite numerous ongoing studies, there is no standardized consensus on managing resistance to third-generation EGFR-TKIs. This consensus integrates international guidelines on EGFR-TKI management, findings from clinical studies, and experiences from the Asia–Pacific region in addressing post-resistance. Detailed recommendations are provided for classification and progression patterns, clinical testing, and post-resistance treatment strategies related to third-generation EGFR-TKI resistance. The aim of these recommendations is to offer reference opinions for the standardized management of patients exhibiting resistance to third-generation EGFR-TKIs in clinical practice.