Induction targeted therapy with tyrosine kinase inhibitors in the treatment of EGFR-positive non-small cell lung cancer. Clinical case and discussion of features of therapeutic «targeted» tumor pathomorphosis

Sukhoversha O.A.1, Tsyhankov K.V.2, Kuzhevskyi I.V.3, Koval S.S.4

Summary. Non-small cell lung cancer (NSCLC) predominates in the structure of LC, representing 80 to 85% of cases at this localization. The 5-year survival rates for NSCLC are quite low. Until recently, the standard treatment for patients with resectable NSCLC included surgical resection followed by preoperative induction (neoadjuvant) and postoperative (adjuvant) chemotherapy/radiation therapy. However, under such an approach, recurrence is a common phenomenon, and the risk of its occurrence increases with the disease stage. Recently, the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and immunotherapy in adjuvant therapy regimens has demonstrated improved progression-free survival (PFS) in NSCLC patients. Osimertinib is an irreversible third-generation oral EGFR-TKI with demonstrated potent efficacy in NSCLC, including PFS in patients with CNS metastases. As for neoadjuvant osimertinib use, its efficacy for surgically operable NSCLC with EGFR mutation remains inadequately studied. Neoadjuvant therapy for resectable NSCLC has the potential advantage of reducing tumor size and ensuring earlier elimination of micrometastatic disease, thereby potentially reducing the risk of disease recurrence. This article provides an overview of studies on the effectiveness of osimertinib use in the neoadjuvant setting and presents the results of our own observations.

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