SPECIAL ARTICLE

ESMO expert consensus statements on the management of EGFR mutant

non-small-cell lung cancer
A. Passaro1*, N. Leighl2y, F. Blackhall3,4y, S. Popat5,6,7y, K. Kerr8y, M. J. Ahn9, M. E. Arcila10, O. Arrieta11, D. Planchard12,
F. de Marinis1, A. M. Dingemans13, R. Dziadziuszko14, C. Faivre-Finn15, J. Feldman16, E. Felip17, G. Curigliano18, R. Herbst19,
P. A. Jänne20, T. John21, T. Mitsudomi22, T. Mok23, N. Normanno24, L. Paz-Ares25, S. Ramalingam26, L. Sequist27,
J. Vansteenkiste28, I. I. Wistuba29, J. Wolf30, Y. L. Wu31, S. R. Yang7, J. C. H. Yang32, Y. Yatabe33, G. Pentheroudakis34 &
S. Peters35
1
Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy; 2Division of Medical Oncology/Hematology, Princess Margaret Hospital Cancer
Centre, Toronto, Canada; 3Division of Cancer Sciences, The University of Manchester, Manchester; 4Department of Medical Oncology, The Christie National Health
Service (NHS) Foundation Trust, Manchester; 5National Heart and Lung Institute, Imperial College, London; 6Lung Unit, Royal Marsden Hospital, London; 7The Institute
of Cancer Research, London; 8Aberdeen Royal Infirmary, Aberdeen University Medical School, Aberdeen, UK; 9Division of Hematology-Oncology, Department of
Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 10Department of Pathology, Molecular Diagnostics Service, Memorial
Sloan Kettering Cancer Center, New York, USA; 11Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico; 12Department of Medical Oncology,
Gustave Roussy, Villejuif, France; 13Department of Respiratory Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The
Netherlands; 14Department of Oncology and Radiotherapy, Medical University of Gda nsk, Gdansk, Poland; 15The University of Manchester, Manchester Academic
16
Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK; Lung Cancer Patient and Advocate, Co-Founder of EGFR Resisters Patient Group;
17
Department of Medical Oncology, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology, Barcelona, Spain; 18Department of Oncology and Hemato-
Oncology, University of Milano, European Institute of Oncology IRCCS, Milan, Italy; 19Yale Comprehensive Cancer Center, Yale University School of Medicine, New
Haven; 20Lowe Center for Thoracic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; 21Peter MacCallum Cancer Centre,
Melbourne, Australia; 22Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan; 23State Key Laboratory of
Translational Oncology, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong, China; 24Cell Biology and Biotherapy and
Scientific Directorate, Istituto Nazionale Tumori, “Fondazione G.Pascale” IRCCS, Naples, Italy; 25Lung Cancer Clinical Research Unit, and Complutense University,
Madrid, Spain; 26Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, Georgia; 27Department of Medicine, Massachusetts General
Hospital, Boston, USA; 28Department of Respiratory Oncology, University Hospital KU Leuven, Leuven, Belgium; 29Department of Translational Molecular Pathology,
Unit 951, The University of Texas MD Anderson Cancer Center, Houston, USA; 30Lung Cancer Group Cologne, Department I for Internal Medicine and Center for
Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany; 31Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital and
Guangdong Academy of Medical Sciences, Guangdong; 32Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center,
Taipei, Republic of China; 33Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan; 34Department of Medical Oncology, University of
Ioannina, Ioannina, Epirus, Greece; 35Oncology Department e CHUV, Lausanne University, Lausanne, Switzerland

Available online 14 February 2022

The European Society for Medical Oncology (ESMO) held a virtual consensus-building process on epidermal growth
factor receptor (EGFR)-mutant non-small-cell lung cancer in 2021. The consensus included a multidisciplinary panel
of 34 leading experts in the management of lung cancer. The aim of the consensus was to develop
recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and
where the available evidence is either limited or conflicting. The main topics identified for discussion were: (i) tissue
and biomarkers analyses; (ii) early and locally advanced disease; (iii) metastatic disease and (iv) clinical trial design,
patient’s perspective and miscellaneous. The expert panel was divided into four working groups to address
questions relating to one of the four topics outlined above. Relevant scientific literature was reviewed in advance.
Recommendations were developed by the working groups and then presented to the entire panel for further
discussion and amendment before voting. This manuscript presents the recommendations developed, including
findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting
each recommendation.
Key words: consensus, lung cancer, treatment, testing, targeted therapy, EGFR

*Correspondence to: Dr Antonio Passaro, Division of Thoracic Oncology, Eu-

ropean Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141,
Milan, Italy. Tel: þ39-0257489826
E-mail: antonio.passaro@ieo.it (A. Passaro).
Twitter handle: APassaroMD
yThese authors contributed equally to this work.
0923-7534/© 2022 European Society for Medical Oncology. Published by
Elsevier Ltd. All rights reserved.
INTRODUCTION
The management of epidermal growth factor receptor
(EGFR)-mutant non-small-cell lung cancer (NSCLC) has
dramatically changed following the introduction of targeted
therapy in the last 15 years. Despite these advances,

466 https://doi.org/10.1016/j.annonc.2022.02.003 Volume 33 - Issue 5 - 2022