Is dacomitinib/dacomitinib suitable for I858R mutation No. 21?

Dacomitinib/Dacomitinib (Dacomitinib) is a second-generation EGFR tyrosine kinase inhibitor (EGFR-TKI), which is mainly used to treat patients with specific EGFR sensitivity. Patients with mutated non-small cell lung cancer (NSCLC), especially those with classic mutations such as exon 19 deletion and exon 21 L858R point mutation, have shown good results. For the L858R mutation in exon 21, this is one of the most common EGFR mutations and accounts for a significant proportion of EGFR-positive non-small cell lung cancer patients. At present, international guidelines and a large amount of clinical use experience at home and abroad have confirmed that patients with L858R mutations have a good response to dacomitinib treatment and therefore belong to the standard population for this drug.

Compared with the first generationEGFR-TKI (such as erlotinib, gefitinib), dacomitinib has stronger irreversible binding ability in inhibiting the EGFR signaling pathway, and also has a synergistic inhibitory effect on receptors such as HER2 and HER4, which makes it possible to have more durable anti-tumor activity in certain mutation backgrounds. For patients with L858R mutations, dacomitinib can provide longer progression-free survival and duration of response than some early EGFR inhibitors. However, it is worth noting that this type of mutation may still produce secondary resistance mutations, such as T790M, after taking targeted drugs. Therefore, it is necessary to closely monitor changes in the disease in clinical practice, and adjust medication strategies or combine with other treatments when necessary.

In current clinical practice, if a patient is diagnosed with the EGFR exon 21 L858R mutation, dacomitinib is usually given priority as one of the first-line treatment options, especially when the patient is not suitable for osimertinib or is resistant to first-generation TKIs. Doctors will develop individualized treatment plans based on factors such as the patient's overall health, mutation type, tolerance, and the presence of brain metastases.

Reference materials:https://www.pfizer.com/products/product-detail/vizimpro