Elsevier

Journal of Thoracic Oncology

Volume 5, Issue 10, October 2010, Pages 1706-1713
Journal of Thoracic Oncology

Meeting Summary
Consensus for EGFR Mutation Testing in Non-small Cell Lung Cancer: Results from a European Workshop

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Introduction:

Activating somatic mutations of the tyrosine kinase domain of epidermal growth factor receptor (EGFR) have recently been characterized in a subset of patients with advanced non-small cell lung cancer (NSCLC). Patients harboring these mutations in their tumors show excellent response to EGFR tyrosine kinase inhibitors (EGFR-TKIs). The EGFR-TKI gefitinib has been approved in Europe for the treatment of adult patients with locally advanced or metastatic NSCLC with activating mutations of the EGFR TK. Because EGFR mutation testing is not yet well established across Europe, biomarker-directed therapy only slowly emerges for the subset of NSCLC patients most likely to benefit: those with EGFR mutations.

Methods:

The “EGFR testing in NSCLC: from biology to clinical practice” International Association for the Study of Lung Cancer-European Thoracic Oncology Platform multidisciplinary workshop aimed at facilitating the implementation of EGFR mutation testing. Recommendations for high-quality EGFR mutation testing were formulated based on the opinion of the workshop expert group.

Results:

Co-operation and communication flow between the various disciplines was considered to be of most importance. Participants agreed that the decision to request EGFR mutation testing should be made by the treating physician, and results should be available within 7 working days. There was agreement on the importance of appropriate sampling techniques and the necessity for the standardization of tumor specimen handling including fixation. Although there was no consensus on which laboratory test should be preferred for clinical decision making, all stressed the importance of standardization and validation of these tests.

Conclusion:

The recommendations of the workshop will help implement EGFR mutation testing in Europe and, thereby, optimize the use of EGFR-TKIs in clinical practice.

Key Words:

Epidermal growth factor receptor
EGFR mutation
EGFR testing recommendations
Gefitinib
Erlotinib
Non-small cell lung cancer
Tyrosine kinase inhibitors

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Disclosure: Robert Pirker, MD, has received speaker's fees and honorari for consulting from AstraZeneca, Boehringer Ingelheim, Merck Serono, and Roche. Keith M. Kerr, MD, FRCPath, has received consulting fees and honoraria from AstraZeneca and Roche. Martin Filipitis, PhD, has received speaker's feed and honoraria for advisory boards from AstraZeneca. Miquel Taron, PhD, has received honoraria for advisory boards and speaker's fees from AstraZeneca. David Gandara, MD, has received consulting fees from Amgen, AstraZeneca, Biodesix, Boehringer Ingelheim, BMS/Imclone, GlaxoSmithKline, Genentech, Merck, Novartis, and Sanofi-Aventis, as well as research grants from Abbott, BMS/Imclone, Genentech, Eli Lilly, Merck, Novartis, and Pfizer. Fred R. Hirsch, MD, has received honoraria for advisory boards from AstraZeneca, OSI, Roche, Genentech, and Boehringer Ingelheim; research grants from AstraZeneca, OSI, and Genentehc; and is an inventor of a University of Colorado-owned patent (EGFR FISH predictive marker for EGFR inhibitors). Helmut Popper, MD, has received honoraria for advisory boards from AstraZeneca and Roche. Manfred Dietel, MD, has received honoraria for scientific advisory boards from AstraZeneca. Peter Schirmacher, MD, had received honoraria fror advisory boards from AstraZeneca and Roche, as well as research grants from AstraZeneca. Rolf Stahel, MD, has received honoraria for scientific advisory boards from AstraZeneca and merck Serono. The other authors declare no conflicts of interest.