Treating EGFR-positive lung cancer
There are different types of EGFR mutation, and which treatment you might have can depend on your exact mutation, as well as the stage of your cancer, your general health and your own preferences. Your medical team should talk to you about the treatments available to you and help you weigh up their possible benefits and side effects.
The treatments available for EGFR-positive lung cancer may differ depending on where you live in the UK. England, Scotland, Wales and Northern Ireland have different systems for deciding which treatments are available through the NHS. This page gives an overview of treatment options, but not every treatment listed will be available in every part of the UK.
Common EGFR mutations: exon 19 deletion and L858R
The two most common EGFR mutations are exon 19 deletion and L858R, which is found in exon 21. Together, these account for around 85–90% of EGFR mutations. (1)
Advanced or metastatic lung cancer
There are now several first-line treatment options available on the NHS in England for people with advanced EGFR-positive lung cancer with an exon 19 deletion or L858R mutation.
Osimertinib (Tagrisso)
Osimertinib is a targeted therapy called a tyrosine kinase inhibitor (TKI). It is taken as a tablet once a day and can be used on its own as a first treatment for advanced EGFR-positive lung cancer. (2)
Osimertinib can work throughout the body, including in the brain, which is important because EGFR-positive lung cancer can sometimes spread to the brain.
Osimertinib plus chemotherapy
Osimertinib can also be given alongside chemotherapy. The chemotherapy used is pemetrexed with either carboplatin or cisplatin. Research has shown that adding chemotherapy to osimertinib can keep the cancer under control for longer than osimertinib alone. However, adding chemotherapy also means more hospital visits and additional side effects. NICE approved this combination as a first-line treatment in 2025. (3)
Amivantamab (Rybrevant) plus lazertinib (Lazcluze)
Another first-line option is amivantamab together with lazertinib. Lazertinib is a TKI taken as a tablet. Amivantamab is a targeted treatment that attaches to proteins on the surface of cancer cells.
NICE approved amivantamab plus lazertinib as a first-line treatment for advanced EGFR-positive lung cancer in 2026. (4)
Choosing a first treatment
There is no single treatment that will be right for everyone.
Some people may prefer Osimertinib alone because it is a tablet taken at home and generally involves fewer hospital visits. Others may choose a combination treatment for the possible added benefit, even though it may mean more side effects and a greater treatment burden.
Your oncologist should discuss the benefits and possible side effects of each option with you, so that you can make a decision together.
Other EGFR targeted therapies
Other TKIs that have been used to treat EGFR-positive lung cancer include:
Afatinib (Giotrif)
Dacomitinib (Vizimpro)
Erlotinib (Tarceva)
Gefitinib (Iressa)
These medicines are still treatment options in some circumstances, although osimertinib and newer combination treatments have changed how common EGFR-positive lung cancer is usually treated.
EGFR exon 20 insertion mutations
EGFR exon 20 insertion mutations are different from the more common exon 19 deletion and L858R mutations. This is important because they do not respond to many of the EGFR targeted therapies in the same way.
Amivantamab (Rybrevant) plus chemotherapy
There is now a targeted first-line treatment specifically for people with advanced NSCLC with an EGFR exon 20 insertion.
Amivantamab can be given with carboplatin and pemetrexed chemotherapy as a first treatment for advanced lung cancer with an EGFR exon 20 insertion mutation. (5)
In 2026, NICE made this treatment available through managed access while more evidence is collected. NICE will look at the new evidence before making a final decision about its routine use.
If you have an exon 20 insertion, talk to your medical team about the treatments available to you and whether a clinical trial might also be suitable.
Uncommon EGFR mutations
Not everyone with EGFR-positive lung cancer has one of the common mutations or an exon 20 insertion. Other EGFR mutations include G719X, S768I and L861Q. Sometimes a cancer has more than one EGFR mutation at the same time. This is known as a compound mutation.6
There is less research on these uncommon mutations, and different mutations can respond differently to EGFR targeted therapies. Afatinib has evidence of benefit for several uncommon EGFR mutations, including G719X and L861Q. Osimertinib may also be an option for some uncommon mutations.(6,7)
If you have an uncommon EGFR mutation, it is particularly important to know the exact mutation found in your cancer. Your oncologist can discuss the evidence for your particular mutation, and you may also want to ask whether there is a suitable clinical trial.
Treatment for earlier-stage EGFR-positive lung cancer
Targeted treatment is no longer used only for advanced EGFR-positive lung cancer.
For people with stage IB to IIIA NSCLC with an exon 19 deletion or L858R mutation whose cancer has been completely removed by surgery, Osimertinib can be given after surgery to reduce the risk of the cancer returning. NICE recommends treatment for up to three years. (8)
For people with stage III EGFR-positive NSCLC that cannot be removed by surgery, Osimertinib is also now an NHS treatment option after platinum-based chemoradiotherapy, as long as the cancer has not grown during or after that treatment.(9)
When treatment stops working
EGFR-positive lung cancer can change over time and become resistant to treatment. This means that a treatment that has been controlling the cancer may eventually stop working.
If this happens, your medical team may recommend another biopsy or a blood test (liquid biopsy) to look for changes in the cancer. This information can sometimes help guide the next treatment.
What happens next will depend on which treatment you have already had, where the cancer has grown, your general health and the results of any further testing. Options may include chemotherapy, other targeted treatments, radiotherapy or a clinical trial.
Research into treatment resistance is moving quickly, and new treatments and combinations continue to be studied.
EGFR-positive lung cancer and the brain
EGFR-positive lung cancer can sometimes spread to the brain.
Osimertinib is able to reach the brain and can be effective against EGFR-positive cancer that has spread there. (10) Other newer treatments are also being studied for their ability to prevent or control cancer in the brain.
Radiotherapy and other treatments may also be used to treat brain metastases. Your medical team will recommend treatment based on your individual circumstances.
Clinical trials
Treatment for EGFR-positive lung cancer is developing rapidly. Clinical trials are exploring new targeted therapies, new treatment combinations, and ways to overcome resistance.
A clinical trial may therefore be an important treatment option at different stages of EGFR-positive lung cancer. You can ask your oncologist whether any trials may be suitable for you.
References
1. Passaro A, et al. Overview on therapeutic options in uncommon EGFR mutant non-small cell lung cancer (NSCLC): new lights for an unmet medical need. International Journal of Molecular Sciences. 2023;24:8878.
2. National Institute for Health and Care Excellence (NICE). Lung cancer: diagnosis and management (NG122). NICE; updated 2026.
3. National Institute for Health and Care Excellence (NICE). Osimertinib with pemetrexed and platinum-based chemotherapy for untreated EGFR mutation-positive advanced non-small-cell lung cancer (TA1060). NICE; 2025.
4. National Institute for Health and Care Excellence (NICE). Amivantamab with lazertinib for untreated EGFR mutation-positive advanced non-small-cell lung cancer (TA1122). NICE; 2026.
5. National Institute for Health and Care Excellence (NICE). Amivantamab with carboplatin and pemetrexed for untreated EGFR exon 20 insertion mutation-positive advanced non-small-cell lung cancer (TA1158). NICE; 2026.
6. John T, et al. Uncommon EGFR mutations in non-small-cell lung cancer: a systematic literature review of prevalence and clinical outcomes. Cancer Epidemiology. 2022;76:102080.
7. American Society of Clinical Oncology (ASCO). Therapy for stage IV non-small-cell lung cancer with driver alterations: ASCO Living Guideline. Updated 2026.
8. National Institute for Health and Care Excellence (NICE). Osimertinib for adjuvant treatment of EGFR mutation-positive non-small-cell lung cancer after complete tumour resection (TA1043). NICE; 2025.
9. National Institute for Health and Care Excellence (NICE). Osimertinib for treating unresectable EGFR mutation-positive non-small-cell lung cancer after chemoradiotherapy (TA1156). NICE; 2026.
10. Reungwetwattana T, et al. CNS response to osimertinib versus standard EGFR tyrosine kinase inhibitors in patients with untreated EGFR-mutated advanced non-small-cell lung cancer. Journal of Clinical Oncology. 2018;36:3290–3297.
Treatment recommendations and availability can change as new evidence becomes available. Treatment options may also differ across England, Scotland, Wales and Northern Ireland. This information is a general guide and should not replace advice from your medical team.