Summary of NSCLC EGFR-TKI drugs with the targeted gene mutations and the working mechanisms

Drug(s)FDA approval specifications and targeted mutationsGeneration
Erlotinib, gefitinib, icotinib

Erlotinib: approved in May 2013 for 1st line metastatic and in November 2004 for 2nd line metastatic NSCLC treatment (efficient for exon 19 and L858R mutated NSCLC)

Gefitinib: approved in July 2015 for 1st line metastatic NSCLC. Was earlier approved in 2003 for 3rd line but got retracted in 2005 (diarrhoea and liver dysfunction were noted as adverse effects)

Icotinib was approved in China in June 2011 and caused fewer AEs than gefitinib (61% against 70%), phase III double-blind study revealed a 3–4 months PFS

First
Afatinib, dacominitib

Afatinib got approval in July 2013 for 1st line metastatic, T790M mutant patients & in January 2018 for 1st line metastatic non-resistant mutations

Dacomitinib was approved in September 2018 for 1st line, metastatic NSCLC patients

Second
Osimertinib, rociletinib, olmutinib, lazertinib

Osimertinib was approved by FDA in November 2015 for treating T790M mutated NSCLC besides controlling CNS metastasis

Rociletinib was screened as active in T790M mutated NSCLC in clinical trials but was not approved by FDA due to its limited efficacy

Olmutinib got FDA approval in December 2015 for T790M mutation harboring NSCLC

Lazertinib got its first FDA approval in January 2021 for L858R, exon 19 deleted and T790M mutated advanced, metastasized NSCLC

Third with CNS penetration
1296P BLU-945, MA07.09 BBT-176, BPI-361175

1296P BLU-945 is efficient in treatment of T790M and C797S mutated, advanced NSCLC

MA07.09BBT-176 was manageably toxic for 20–600 mg intake on daily basis, emerging suitable to treat exon 19 deleted, T790M & C797S mutated, advanced NSCLC

BPI-361175 prolonged the life span of exon 19 deleted & T790M/C797S mutated NSCLC in mice models with significant control of CNS metastasis. Currently, it is being evaluated in phase I clinical trials in China & US

Fourth

AEs: adverse events; PFS: progression-free survival; CNS: central nervous system