Targeted therapy for stage IA non-small cell lung cancer with EGFR mutations: a scoping review

Patients with stage IA epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) also face recurrence risk, yet whether targeted therapy should be performed remains controversial. We attempted to synthesize all existing studies in this field to provide valuable insights for clinical decision-making and future research.

This scoping review was conducted following PRISMA-ScR. Searches of nine literature databases and six clinical trial registries were completed on June 18, 2025. Literature selection and data extraction were performed using double-blinded and third-party arbitration methods. Findings were categorized into direct evidence, indirect evidence, and ongoing trials, visualized in tabular and graphical formats.

We retrieved 3,308 records. After a two-step screening process, 33 published studies and 22 ongoing clinical trials were retained. Among the 33 publications, 12 served as direct evidence sources and 21 as indirect evidence sources, all reporting potential benefits of EGFR-tyrosine kinase inhibitors (EGFR-TKIs). Publications release and clinical trials initiation were concentrated after 2020, with China as the primary country of conduct. Among the studies, first-generation erlotinib and third-generation osimertinib were the most frequently used agents. Common high-risk factors included micropapillary, solid, complex gland components (CGC), spread through air spaces (STAS), minimal residual disease (MRD), and lymphovascular invasion (LVI).

Direct evidence for targeted therapy in patients with stage IA EGFR mutation-positive NSCLC remains limited, largely due to the relatively recent initiation of research. However, existing evidence demonstrates the therapeutic potential of EGFR-TKIs. Multiple ongoing clinical trials may offer promising outcomes, yet numerous questions remain for answer. Overall, stage IA EGFR mutation-positive patients may benefit from EGFR-TKIs.