EGFR Testing For Advanced Lung Cancer

Alternatively, the guidelines state that gefitinib can be used in place of erlotinib “in areas of the world where it is avail­able.” 

For patients in whom the EGFR mu­tation is discovered during chemothera­py, the guidelines recommend either adding erlotinib to the current chemotherapy protocol or switching to erlotinib as maintenance treatment.

For patients whose EGFR status is negative or unknown, even in the pres­ence of clinical characteristics that might be suggestive of a mutation (for exam­ple, female, nonsmoker, Asian race), con­ventional chemotherapy is recommended, Dr. Ettinger said. 

In an editorial that accompanied ASCO’s PCO announcement, Dr. Paul A. Bunn Jr. and Dr. Robert C. Doebele of the University of Colorado Cancer Center in Aurora wrote that the grow­ing clinical importance of molecularly defined subgroups of adenocarcinoma signals a “new era of personalized med­icine for patients with advanced lung cancer, in which it will be imperative to match the specific mutations of a patient’s tumor with a specific therapy.” 

The implemen­tation of routine, simultaneous testing of multiple markers will likely be con­ducted on all patients prior to treat­ment initiation, regardless of clinical features, they stated, acknowledging certain procedural challenges, includ­ing obtaining adequate tumor materi­al at the time of diagnostic biopsy and developing testing platforms “that si­multaneously analyze for the presence of somatic mutations, gene fusions, or other genetic challenges.”

The updated NCCN Guidelines for NSCLC are posted at www.nccn.org. The ASCO PCO is posted at www.asco.org/ascov2/Practice+&+Guidelines/Guidelines/Provisional+Clinical+Opinion.

Dr. Ettinger has consultancy agree­ments with the a number of pharma­ceutical companies Dr. Keedy receives commercial research support from Ari­ad Pharmaceuticals, Ziopharm Oncolo­gy, and Amgen Oncology Therapeutics. Dr. Bunn has a consultant or advisory role with a number of pharmaceutical companies. Dr. Doebele disclosed re­search funding from Lilly, ImClone Sys­tems, and Pfizer.