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Consensus for EGFR mutation testing in non-small cell lung cancer: results from a European workshop
Robert Pirker1, Felix J F Herth, Keith M Kerr
1Medical University of Vienna, Vienna, Austria. robert.pirker@meduniwien.ac.at
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.
Insights
Implementing epidermal growth factor receptor (EGFR) mutation testing in Europe is crucial for optimizing EGFR tyrosine kinase inhibitor (TKI) use in non-small cell lung cancer (NSCLC) patients. Recommendations focus on standardized testing for better biomarker-directed therapy.
Area of Science:
- Oncology
- Genetics
- Pharmacology
Background:
- Activating somatic mutations in the epidermal growth factor receptor (EGFR) tyrosine kinase domain are identified in a subset of advanced non-small cell lung cancer (NSCLC) patients.
- Tumors with these EGFR mutations demonstrate significant response to EGFR tyrosine kinase inhibitors (EGFR-TKIs).
- Gefitinib, an EGFR-TKI, is approved in Europe for advanced or metastatic NSCLC with activating EGFR mutations, yet its use is limited by inconsistent testing.
Framework:
- The International Association for the Study of Lung Cancer-European Thoracic Oncology Platform convened a multidisciplinary workshop to address EGFR mutation testing implementation.
- Expert group consensus formed the basis for recommendations on high-quality EGFR mutation testing.
Implementation:
- Effective interdisciplinary cooperation and communication are paramount for successful implementation.
- Treating physicians should initiate EGFR mutation testing requests, with results expected within seven working days.
- Standardization of tumor specimen handling, including fixation and sampling techniques, is essential for reliable testing.
Implications:
- Adoption of these recommendations will facilitate widespread EGFR mutation testing across Europe.
- Optimized EGFR-TKI utilization in clinical practice is anticipated, improving outcomes for NSCLC patients with EGFR mutations.
