Prevalence and Patterns of EGFR Mutations in Non-Small Cell Lung Cancer in the Middle East and North Africa: A Systematic Review

To summarize current evidence and estimate the prevalence of epidermal growth factor receptor (EGFR) mutation frequency and its association with ethnicity and clinic-pathological features in non-small cell lung cancer (NSCLC) patients in the Middle East (ME) and North Africa (NA), a systematic literature review was undertaken. We conducted a literature search of original articles published in six databases (PubMed, Science Direct, Web of Science, Embase, Scopus, and Google scholar) from the time of inception until April 2021. Search terms included “lung cancer”, “NSCLC”, “EGFR mutation”, “Middle East”, “North Africa”, and specific country names belonging to the considered region. The included studies had to meet the following criteria: the study must relate to the role of the EGFR gene in NSCLC, analyze mutations in exon 18, 19, 20, and 21 or select exons of the EGFR gene, and provide sufficient information on the clinic-pathological characteristics of the included NSCLC patients. A total of 24 eligible studies were included [(66.6%) in the ME and (34.4%) in NA]. Overall, 6544 patients with NSCLC were analyzed for EGFR mutations [(55.1%) in the ME and (44.8%) in NA]. The overall prevalence of EGFR mutations was 17.9%. In the ME, the reported frequency was 17.3%, whereas in NA, the prevalence of EGFR mutations was 18.5%. The most frequently encountered mutations were the exon 19 deletions (45.2%) and exon 21 substitutions (30.9%). Exon 20 alterations were detected in 11.2%, of which, the T790M resistance mutation was the most prevalent (45.5%). Exon 18 mutations were reported in 3.8%. In the ME, 50.5% of NSCLC patients were positive for exon 19 deletions versus 48.3% in NA. Exon 21 mutations were slightly more commonly detected in the ME (36.3%) than NA (31.3%). There was 1.2% of patients that had concurrent EGFR mutations. Overall, EGFR mutations prevalence was higher in females, non-smokers, and patients with adenocarcinoma. Our systematic literature review concurs that EGFR mutation prevalence among MENA populations is slightly higher than that seen in NSCLC patients of Caucasian ethnicity but is lower than that identified in Asian NSCLC patients. The distribution of these mutations varies significantly throughout the MENA region.