Epidermal growth factor receptor (EGFR) positive non-small-cell lung carcinoma (NSCLC) patients in the Gulf region: current status, challenges, and call for action

EGFR mutations commonly occur in exon 19 or 21 (approximately 45 and 40% of patients, respectively) in NSCLC patients that activate the tyrosine kinase domain in epidermal growth factor receptors.5 As EGFR mutational status is critical in the management of advanced stage lung cancer, early EGFR testing has gained importance over time so as to provide timely and personalized treatment therapies to such patients.6 National Comprehensive Cancer Network (NCCN) guidelines recommend the use of EGFR tyrosine kinase inhibitors (TKIs) (gefitinib, erlotinib, afatinib, osimertinib and dacomitinib) as the first line agents for the treatments of EGFR positive NSCLC patients.7 TKIs have demonstrated improved progression-free survival (PFS), higher response rates, better overall quality of life, and fewer side effects in comparison to standard platinum-based chemotherapy.8–10 However, disease progression secondary to acquired resistance to TKI treatment (after a median of 10-14 months), occurred in up to 60% of patients due to acquired T790M mutations11 while primary T790M mutations are very rare.12