by Dr. C.H. Weaver M.D. updated 1/2019
Large-scale screening for epidermal growth factor receptor mutations in lung cancer is feasible and allows for customization of treatment with Tarceva® (erlotinib), thereby improving outcomes, according to the results of a study published in the New England Journal of Medicine.
Non–small cell lung cancer accounts for approximately 75-80% of all lung cancers. “Non–small cell” refers to the type of cell within the lung from which the cancer originated. Newer therapies for NSCLC consist of targeted agents that block the epidermal growth factor receptor (EGFR) pathway.
The EGFR is a pathway that is involved in cell replication and growth. It is often overexpressed or mutated within cancer cells. Tarceva and Iressa® (gefitinib) are targeted therapies that work by blocking the EGFR pathway. EGFR mutations are more common in women, non-smokers, and patients with adenocarcinomas. Patients with EGFR mutations have been shown to have a better response to Tarceva and Iressa than those without the mutation; therefore, researchers have speculated that screening for the mutation could improve outcomes for this patient population.
This prospective study involved 2,105 patients in 129 institutions in Spain. The patients were screened for EGFR mutations using specimens from the original biopsy prior to any treatment. Patients who were identified with an EGFR mutation were then eligible for treatment with Tarceva.
EGFR mutations were identified in 350 patients; 217 of whom received Tarceva. Median progression-free survival was 14 months, and median overall survival was 27 months. In women, the median progression-free survival was 16 months, and the median overall survival was 29 months. In men, the median progression-free survival was nine months, and median overall survival was 18 months.
The most common adverse events were skin rashes and diarrhea, most often grade 1 and 2 in severity. Sixteen patients experienced grade 3 toxic effects in the skin, and eight patients experienced grade 3 diarrhea.
The researchers concluded that screening for EGFR mutations is warranted and feasible in women, non-smokers, and patients with adenocarcinomas. They speculate that this would allow physicians to customize treatment with Tarceva and improve outcomes in these patients.
 Rosell R, Moran T, Queralt C, et al. Screening for epidermal growth factor receptor mutations in lung cancer. New England Journal of Medicine. [early online publication]. August 19, 2009.
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