Medical Oncology Department, University Hospital Lozano Blesa, IIS Aragón, Avda. San Juan Bosco, 15, 50009, Zaragoza, Spain.
Medical Oncology Department, University Hospital La Paz-IDIPAZ, Madrid, Spain.
Clin Transl Oncol. 2021 Jul;23(7):1304-1313. doi: 10.1007/s12094-020-02518-0. Epub 2020 Nov 18.
To stablish a consensus on the treatment strategy for advanced non-small-cell lung cancer (aNSCLC) with epidermal growth factor receptor mutation (EGFRm) in Spain.
After a systematic literature review, the scientific committee developed 33 statements in 4 fields: molecular diagnosis (10 items); histologic profile and patient clinical characteristics (7 items); first-line (1L) treatment in EGFRm aNSCLC (8 items); and subsequent-line treatment (8 items). A panel of 31 experts completed 2 Delphi online questionnaires rating their degree of agreement/disagreement for each statement through a 1-9 range scale (1-3 = disagree, 7-9 = agree). Consensus was reached if 2/3 of the participants are in the median range.
In the first Delphi round consensus was achieved for 24/33 of the statements. One of the assertions was deleted, proceeding to a second round with the eight remaining questions with no consensus or in the range of indeterminacy. Determination of the EGFR status from tissue and analysis of the different biomarkers are two important variables that influenced treatment decision in patients with aNSCLC. 1L treatment should be the best therapeutic option, independently of the subsequent lines of treatment. For patients with the most common activating mutations osimertinib was considered the most efficient and safe 1L option. In case of disease progression, a new biopsy was needed.
A consensus document is proposed to optimize the treatment strategy for untreated patients with a NSCLC with EGFR sensitizing mutations.
在西班牙就表皮生长因子受体突变（EGFRm）的晚期非小细胞肺癌（aNSCLC）的治疗策略达成共识。
在系统的文献回顾之后，科学委员会在四个领域制定了 33 项声明：分子诊断（10 项）；组织学特征和患者临床特征（7 项）；EGFRm aNSCLC 的一线（1L）治疗（8 项）；以及二线治疗（8 项）。由 31 名专家组成的小组完成了两轮在线 Delphi 问卷调查，通过 1-9 范围评分（1-3=不同意，7-9=同意）对每个声明的同意/不同意程度进行评分。如果 2/3 的参与者处于中位数范围，则达成共识。
在第一轮 Delphi 中，有 24/33 项声明达成共识。有一项声明被删除，然后进行第二轮，有 8 项剩余问题没有达成共识或处于不确定范围。从组织中确定 EGFR 状态和分析不同的生物标志物是影响 NSCLC 患者治疗决策的两个重要变量。1L 治疗应该是最佳治疗选择，与后续治疗无关。对于最常见的激活突变患者，奥希替尼被认为是最有效和安全的 1L 选择。在疾病进展的情况下，需要进行新的活检。
提出了一份共识文件，以优化 EGFR 敏感突变的未经治疗的 aNSCLC 患者的治疗策略。
