ESMO E-Learning: How to Use EGFR Mutations to Optimise Treatment Selection in NSCLC

Learning Objectives

  • To understand how to select NSCLC candidate patients for targeted therapies.
  • To understand the role of EGFR Mutations in lung cancer.
  • To understand the role of EGFR Gene copy number and sensitivity to EGFR-TKIs.

After two years E-Learning modules are no longer considered current. There is therefore no CME test associated with this E-Learning module.

Federico Cappuzzo
Federico Cappuzzo
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Epidermal growth factor (EGF) pathway inhibition is now established as an option for the first-, second- and third-line treatments of non–small-cell lung cancer (NSCLC). Tyrosine kinase inhibitors (TKIs) of the EGF receptor (EGFR), erlotinib and gefitinib, have received global approval for treatment in the second- and third-line settings; in Europe, gefitinib is approved for all lines of therapy (including first line) in patients whose tumours harbour EGFR sensitising Mutations in exons 19 or 21.

Clinicians observed that striking benefits with EGFR TKIs were seen predominantly in certain subsets of patients with NSCLC (life-long never smokers, Asian people, women, and those with adenocarcinoma histology). It soon became clear that the molecular mechanism underpinning dramatic responses in these patients was the presence of activating mutations in the EGFR TK domain. Apart from EGFR mutation analysis, other markers, such as EGFRexpression analysis by immunohistochemistry (IHC), EGFR copy number by fluorescent in situ hybridisation (FISH), and K-Ras mutations have also been evaluated to identify patients likely to respond.

This presentation outlines debated question of how EGFR markers should be incorporated into clinical decision making. It highlights factors predictive for response, primary/acquired resistance and survival. Furthermore, it provides an excellent overview of retrospective and prospective studies of EGFR-TKIs in EGFR mutated NSCLC. This is with regards to information on treatment that patients are likely to benefit from and oncologists have learnt, resulting in the development of improved future strategies.

This E-Learning module was published in 2010 and expired in 2012.

Last update: 28 May 2010

The author has reported no conflicts of interest.