Assessing EGFR gene mutation status in non-small cell lung cancer with imaging features from PET/CT

Lung cancer ranks first in the incidence and mortality of cancer in the world, of which more than 80% are non-small cell lung cancer (NSCLC). The majority of NSCLC patients are in stage IIIB~IV when they are admitted to hospital and have no opportunity for surgery. Compared with traditional chemotherapy, specific targeted therapy has a higher selectivity and fewer adverse reactions, providing a new treatment direction for advanced NSCLC patients. Tyrosine kinase inhibitors of epidermal growth factor receptor (EGFR-TKIs) are the widely used targeted therapy for NSCLC patients. Their efficacy and prognosis are closely related to the mutation status of the EGFR gene. Clinically, detecting EGFR gene mutation is often limited by difficulty obtaining tissue specimens, limited detecting technology, and economic conditions, so it is of great clinical significance to find indicators to predict EGFR gene mutation status. Clinicopathological characteristics, tumor markers, liquid biopsy, and other predictors are less invasive, economical, and easier to obtain. They can be monitored in real-time, which is supposed to predict EGFR mutation status and provide guidance for the accurate, individualized diagnosis and therapy of NSCLC patients. This article reviewed the correlation between the clinical indicators and EGFR gene mutation status in NSCLC patients.

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Correlation between EGFR gene mutation, cytologic tumor markers, 18F-FDG uptake in non-small cell lung cancer

BMC Cancer ◽

10.1186/s12885-016-2251-z ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 21

Author(s):

Arthur Cho ◽

Jin Hur ◽

Yong Wha Moon ◽

Sae Rom Hong ◽

Young Joo Suh ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Gene Mutation ◽

Tumor Markers ◽

Cell Lung Cancer ◽

Small Cell ◽

Small Cell Lung ◽

Egfr Gene ◽

18F Fdg ◽

Egfr Gene Mutation

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Differential effect of erlotinib on survival of patients with non-small cell lung cancer in terms of EGFR status: A meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e18024 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e18024-e18024

Author(s):

Nay Min Tun ◽

Asha Nayak

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Gene Mutation ◽

Differential Effect ◽

Meta Analysis ◽

Small Cell ◽

Small Cell Lung ◽

Egfr Gene ◽

Nsclc Patients ◽

Egfr Gene Mutation

e18024 Background: Erlotinib is a small-molecule tyrosine kinase inhibitor that inhibits the protein kinase activity of epidermal growth factor receptor (EGFR). The primary objective of this meta-analysis is to compare the response of patients with EGFR-positive versus EGFR-negative advanced non-small-cell lung cancer (NSCLC) to erlotinib in terms of overall survival (OS) and progression-free survival (PFS). Methods: A Medline search using the MeSH terms “erlotinib” and “lung” in the title field, filtered by ‘clinical trial’, yielded 108 articles. Clinical trials involving erlotinib with available survival data on EGFR-positive versus EGFR-negative NSCLC were searched for. The intervention effect estimate and standard error of each study was derived from the hazard ratio (HR) and p value. Generic inverse variance method was applied to compute the overall effect size and HR with 95% confidence interval (CI). Fixed or random effects model was used according to the level of between-study heterogeneity. Results: 3 studies including 504 patients were eligible for the analysis. All patients received erlotinib in a single arm. EGFR gene mutation was tested in 326 patients (35 mutation-positive, 188 wild-type, 103 indeterminate). EGFR gene amplification by fluorescent in-situ hybridization (FISH) was studied in 353 patients (100 positive), and EGFR protein expression by immunohistochemistry (IHC) in 368 patients (290 positive). Patients with EGFR gene mutation had significantly longer PFS (HR = 0.4, CI 0.25-0.64, p = 0.0001) but not OS (HR = 0.59, CI 0.18-1.95, p = 0.39). In contrast, EGFR FISH-positivity was associated with better PFS as well as OS (HR = 0.52, CI 0.39-0.71, p < 0.00001 and HR = 0.65, CI 0.47-0.88, p = 0.006, respectively). Conclusions: Results of EGFR gene amplification by FISH rather than EGFR gene mutation by PCR may be a better predictor of survival for advanced NSCLC patients receiving erlotinib. Subgroup analyses of erlotinib's differential effect on NSCLC patients with regard to their EGFR status (as measured by PCR, FISH or IHC) are further warranted in randomized controlled trials.

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