EGFR positive lung cancer

Epidermal growth factor receptor, commonly known as EGFR positive lung cancer, is a type of non-small cell lung cancer (NSCLC).  

In this page, we’ll cover:

• What is EGFR positive lung cancer?
• How EGFR positive lung cancer is diagnosed
• Treatments for EGFR+ lung cancer
• Side effects
• Can EGFR+ lung cancer by cured?
• Support for people with EGFR+ lung cancer.

What is EGFR positive lung cancer?

The EGFR+ mutation is present in 5-10% of people with lung cancer, though this can be much higher in people of Eastern Asian descent.

EGFR mutations are:

• More common in women than men
• Most common in people with lung adenocarcinoma, but can be found in people with other subtypes of non-small cell lung cancer 
• Often found in never-smokers or people who smoked only lightly 
• More common in young adults with lung cancer 
• More common in people from Asia, especially East Asia

Epidermal growth factor receptor (EGFR) is a protein that is present on the surface of both normal cells and cancer cells. 

If there is a mutation in the EGFR gene, it can make the cells grow too much and can cause cancer.

Where a biopsy and molecular tests have found a mutation in the EGFR gene, it is called EGFR-positive (or EGFR+) lung cancer.

There are different types of EGFR+ lung cancer including:

• EGFR exon 19 deletions
• EGFR exon 21 L858R mutations
• EGFR exon 20 insertions
• T790M-like mutations.

The type of lung cancer you have can determine what treatments are available to you, or how you respond to treatment.

How EGFR positive lung cancer is diagnosed

When you are diagnosed with lung cancer, you will undergo a series of tests to understand what type of lung cancer you had, what stage your lung cancer is and what are the best ways to treat it.

One of these tests should be a genomic test. A genomic test checks cancer cells for important genetic changes (variants). Testing lung cancer in this way is a vital early step in making sure you on the best treatment plan.

Your clinical team will collect some tissue from your tumour in a procedure called a biopsy. If a tissue biopsy cannot be performed, your clinical team may take a blood sample.

Your biopsy will be sent to a laboratory for analysis and a report will be sent to your clinical team. This can take days to weeks, but you may want to ask your clinical team when to expect the results. The National Lung Cancer Optimum pathway recommends test results should be available within 10 days for newly diagnosed.

Your clinical team will explain the results of the test and discuss implications for your treatment, if any, including whether a targeted therapy may be an option available to you.

Every patient should have their sample tested to ensure opportunity for treatments are not missed. If you have not had this test, it is important to speak to your lung cancer team.

Treatments for EGFR+ lung cancer

Like all lung cancers, if it is caught early enough and before it has spread to other parts of the body, surgery is usually the preferred treatment option.

If EGFR+ lung cancer is caught at a later stage, it is typically treated with a targeted therapy. Targeted cancer drugs come in tablet form which you can take at home each day. You do not need to go to hospital to receive this treatment.

There are currently six drugs approved for treating ALK positive lung cancer:

• Afatinib (brand name Giotrif®)
• Dacomitinib (brand name Vizimpro®)
• Erlotinib (brand name Tarceva®)
• Gefitinib (brand name Iressa®) 
• Mobocertinib (brand name Exkivity®) 
• Osimertinib (brand name Tagrisso®).

Osimertinib may be offered as a second line treatment following Afatinib, Dacomitinib, Erlotinib or Gefitinib if the treatment has stopped working and your lung cancer tests positive for the T790M mutation. 

For some people with certain rare EGFR mutations, Afatinib or Erlotinib may be offered as second-line treatment after chemotherapy. 

Mobocertinib may be offered to you, following chemotherapy, if your locally advanced or metastatic NSCLC has tested positive for the EGFR mutation with the exon 20 insertion. Osimertinib may be offered to some people after surgery, whose lung cancer tests positive for an EGFR mutation, usually for a maximum of three years. Subsequent treatments may include chemotherapy or immunotherapy, or a combination of both.

Your lung cancer team will decide which targeted therapy is best suited to treat your lung cancer. This will depend on several factors including if you have received any previous treatment. 

Potential side effects

People taking a targeted therapy do often experience some side effects, especially when they first start treatment. Gradually, your body is likely to adapt to the treatment and the side effects reduce. 

Common side effects can include:

• Diarrhoea
• Nail infections (paronychia)
• Feeling nauseous or being sick
• Rash or other skin problems.

Some people also suffer with more severe side effects. If you experience any of the following, you need to contact your lung cancer team:

• Breathing difficulties, shortness of breath or worsening breathing problems 
• A cough 
• A high temperature (37.5C or higher) 
• Chest pain 
• Slow pulse (50 beats per minute or less), feeling tired, dizzy or faint, or losing consciousness
• Abdominal (belly) pain
• Back pain
• Itching 
• Yellowing of the skin and eyes 
• Changes in mental processes such as confusion, memory loss, and reduced ability to concentrate 
• Changes in mood including irritability and mood swings 
• Changes in speech including difficulty speaking, such as slurred or slow speech.

If you are having from side effects of your treatment, don’t suffer in silence. Your lung cancer team can help reduce side effects but only if you let them know.

Can EGFR+ lung cancer be cured?

When lung cancer is caught early, it is possible to treat with the aim to cure the disease.

Sadly, many people diagnosed with EGFR+ lung cancer are caught at late-stage disease, when the cancer has already spread to other parts of their body.

However, even though stage 4 EGFR+ lung cancer isn’t curable, it is treatable and new treatments, like targeted therapies such as Osimertinib, are helping people to live well for far longer with late-stage disease.