Afatinib in lung cancer harboring EGFR mutation in the LUX-Lung trials: six plus three is greater than seven?

Non-small cell lung cancer (NSCLC) harboring activating mutations of the epidermal growth factor receptor (EGFR) gene, about 90% of which is either small deletion in exon 19 (Del19) or a leucine to an arginine substitution at codon 858 (L858R), is very sensitive to EGFR tyrosine kinase inhibitors (TKIs) such as gefitinib and erlotinib (1). Phase III trials comparing these agents with platinum doublet chemotherapy showed significant prolongation of progression free survival (PFS) in favor of EGFR-TKIs (Figure 1A) (2-5).