Epidermal Growth Factor ReceptorMutation Testing in the Care of Lung Cancer Patients
| Autor: | Victoria A. Joshi, Pasi A. Jänne, Thomas J. Lynch, Peter Verlander, Panos Fidias, Bruce E. Johnson, Daniel A. Haber, Jeffrey C. Lee, Eugene J. Mark, Neal I. Lindeman, Matthew Meyerson, Daphne W. Bell, Raju Kucherlapati, David N. Louis, Lecia V. Sequist, Janina A. Longtine |
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| Rok vydání: | 2006 |
| Předmět: |
Oncology
Cancer Research medicine.medical_specialty Lung Neoplasms DNA Mutational Analysis medicine.disease_cause Gefitinib Carcinoma Non-Small-Cell Lung Internal medicine medicine Adjuvant therapy Humans Epidermal growth factor receptor Lung cancer Mutation biology business.industry Cancer Genes erbB-1 medicine.disease Immunology biology.protein Erlotinib business Tyrosine kinase medicine.drug |
| Zdroj: | Clinical Cancer Research. 12:4403s-4408s |
| ISSN: | 1557-3265 1078-0432 |
| Popis: | As the literature about epidermal growth factor receptor (EGFR) mutations grows and screening for mutations becomes increasingly integrated into clinical care, it is important to examine how best to do somatic mutational analyses and how best to use the test results in clinical decision making. We began offering mutation screening by comprehensive direct sequence analysis of exons 18 to 24 of the tyrosine kinase domain of EGFR in August 2004 as part of clinical cancer care and protocol therapy at our institutions. All identified potential mutations are confirmed with three to five independent PCRs of the original genomic DNA sample and, if not previously noted in the literature, are compared with the patient's germ-line DNA to ensure the finding is somatic. We formally analyzed the first 100 patients to undergo EGFR sequence analysis and found that testing was feasible and significantly affected the treatment of patients with non–small cell lung cancer (NSCLC). Patients harboring EGFR mutations were significantly more likely to receive recommendations for therapy with EGFR tyrosine kinase inhibitors (i.e., gefitinib or erlotinib) than patients without mutations. However, negative EGFR test results did not prevent physicians from administering these agents to selected patients. Ideally, a standardized technique for mutation testing could be developed, with demonstrated reproducibility and validity. Clinical trials incorporating molecular diagnostics are ongoing to assess the efficacy of EGFR tyrosine kinase inhibitors as first-line therapy for metastatic NSCLC and as adjuvant therapy for early-stage resected NSCLC. It is likely that mutation testing and other molecular analyses will be most useful in these two clinical situations. |
| Databáze: | OpenAIRE |
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