Abstract
Screening for EGFR mutation is a key molecular test for management of lung cancer patients. Outcome of patients with mutation receiving EGFR tyrosine kinase inhibitor is known to be better across different ethnic populations. However, frequency of EGFR mutations and the clinical response in most other ethnic populations, including India, remains to be explored. We conducted a retrospective analysis of Indian lung cancer patients who were managed with oral tyrosine kinase inhibitors. Majority of the patients in the study had adenocarcinoma and were non-smokers. 39/111 patients tested positive for EGFR kinase domain mutations determined by Taqman based real time PCR. The overall response to oral TKI therapy was 30%. Patients with an activating mutation of EGFR had a response rate of 74%, while the response rate in patients with wild type EGFR was 5%, which was a statistically significant difference. Progression free survival of patients with EGFR mutations was 10 months compared to 2 months for EGFR mutation negative patients. Overall survival was 19 months for EGFR mutation patients and 13 months for mutation negative patients. This study emphasizes EGFR mutation as an important predictive marker for response to oral tyrosine kinase inhibitors in the Indian population.
Highlights
The immense scientific advances made in the past decade have facilitated the in depth characterization of different disease subtypes, based on their genetic profiles
These mutations serve as markers for predicting the response in patients to oral tyrosine kinase inhibitors targeted to the epidermal growth factor receptor (EGFR) tyrosine kinase
Characteristics of the study population Between January 2010 and July 2012, there were 111 patients who were enrolled in the study from whom a biopsy sample was available, mutation detection was successfully performed, oral tyrosine kinase inhibitors (TKI) was used as therapy and full clinical details were available
Summary
The immense scientific advances made in the past decade have facilitated the in depth characterization of different disease subtypes, based on their genetic profiles. This has profound implications in non small cell lung cancer (NSCLC) which is the commonest cause of cancer deaths worldwide [1]. It has been observed that patients who respond well to an EGFR inhibitor harbor certain mutations in the EGFR exons 18, 19 or 21. In patients whose tumors harbor the EGFR mutation, the use of an EGFR TKI has led to increased response rate and prolongation of progression free survival [5]. EGFR mutations are more likely to occur in patients of
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