For patients with metastatic NSCLC with sensitizing EGFR mutations who progress on first line TKI therapy who do not have evidence of T790M mutation, do you add cetuximab (with afatinib) or bevacizumab (with erlotinib) at progression?

Treatment paradigms have altered considerably over the past two years for patients with EGFR mutations There are now three approved TKIs (afatinib, gefitinib, erlotinb) that all have demonstrated improved outcomes when compared to chemotherapy. In addition, the addition of bevacizumab to erlotinib improved both response rates and progression free survival for EGFR positive patients in a phase II trial from Japan. If considering bevacizumab , I would opt for giving it upfront with erlotinib, not at the time of progression as we just don't have any data. That said, I don't generally incorporate bevacizumab into frontline decisions.

At the time of progression in which a treatment change is warranted, it is paramount to interrogate for T790M (p...