For untreated patients with minimal complaints and good PS with metastatic adenocarcinoma positive for Exon 21 L858R mutation, how do you choose among the available first line EGFR directed therapies?  

Based on the secondary analyses of Lux-Lung 3  and Lux-Lung 6, which showed a survival advantage for afatinib vs platinum-based chemo in patients with exon 19 deletions, I've generally turned to afatinib in this group, while reserving erlotinib for those with exon 21 mutaitons.  Lux-Lung 7...

I agree with @Corey J. Langer's approach and also use afatinib preferentially for exon 19 deletions. Some feel the toxicity may be higher with afatinib than erlotinib or gefitinib, but we have found it manageable with close follow up. An analysis of dose reductions in patients on the Lux-Lung 3 and ...