Background A clinical trial that compared erlotinib with a placebofor nonsmall-cell lung cancer demonstrated a survivalbenefit for erlotinib. We used tumor-biopsy samples from participantsin this trial to investigate whether responsiveness to erlotiniband its impact on survival were associated with expression bythe tumor of epidermal growth factor receptor (EGFR) and EGFRgene amplification and mutations.
Methods EGFR expression was evaluated immunohistochemicallyin nonsmall-cell lung cancer specimens from 325 of 731patients in the trial; 197 samples were analyzed for EGFR mutations;and 221 samples were analyzed for the number of EGFR genes.
Results In univariate analyses, survival was longer in the erlotinibgroup than in the placebo group when EGFR was expressed (hazardratio for death, 0.68; P=0.02) or there was a high number ofcopies of EGFR (hazard ratio, 0.44; P=0.008). In multivariateanalyses, adenocarcinoma (P=0.01), never having smoked (P<0.001),and expression of EGFR (P=0.03) were associated with an objectiveresponse. In multivariate analysis, survival after treatmentwith erlotinib was not influenced by the status of EGFR expression,the number of EGFR copies, or EGFR mutation.
Conclusions Among patients with nonsmall-cell lung cancerwho receive erlotinib, the presence of an EGFR mutation mayincrease responsiveness to the agent, but it is not indicativeof a survival benefit.
Source Information
From the University Health Network, Princess Margaret Hospital Site, and the Ontario Cancer Institute, University of Toronto, Toronto (M.-S.T., A.S., J.-C.C., C.-Q.Z., S.K.-R., J.S., T.Z., N.L., P.M., G.C.S., F.A.S.); the Ottawa Health Research Institute, University of Ottawa, Ottawa (I.L., M.D., A.L.); OSI Pharmaceuticals, Boulder, Colo. (F.R.); and the National Cancer Institute of Canada Clinical Trials Group and Queen's University, Kingston, Ont., Canada (L.S., M.W., K.D., J.P.). Drs. Sakurada, Cutz, and Zhu contributed equally to this article.
Erlotinib in Lung Cancer
Nabhan C., Bitran J. D., Takano T., Ohe Y., Pao W., Ladanyi M., Miller V. A., the Lung Cancer Oncogenome Group , Shepherd F. A., Seymour L., Tsao M.-S., Kamel-Reid S., Shepherd F. A.
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N Engl J Med 2005;
353:1739-1741, Oct 20, 2005.
Correspondence
Assessing EGFR Mutations
Marchetti A., Felicioni L., Buttitta F., Tsao M.-S., Kamel-Reid S., Shepherd F. A.
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N Engl J Med 2006;
354:526-528, Feb 2, 2006.
Correspondence
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Dziadziuszko, R, Holm, B, Skov, B., Osterlind, K, Sellers, M., Franklin, W., Bunn, P. Jr, Varella-Garcia, M, Hirsch, F.
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Wakelee, H. A., Chang, E. T., Gomez, S. L., Keegan, T. H., Feskanich, D., Clarke, C. A., Holmberg, L., Yong, L. C., Kolonel, L. N., Gould, M. K., West, D. W.
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Kato, T., Hayama, S., Yamabuki, T., Ishikawa, N., Miyamoto, M., Ito, T., Tsuchiya, E., Kondo, S., Nakamura, Y., Daigo, Y.
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Chen, H.-Y., Yu, S.-L., Chen, C.-H., Chang, G.-C., Chen, C.-Y., Yuan, A., Cheng, C.-L., Wang, C.-H., Terng, H.-J., Kao, S.-F., Chan, W.-K., Li, H.-N., Liu, C.-C., Singh, S., Chen, W. J., Chen, J. J.W., Yang, P.-C.
(2007). A Five-Gene Signature and Clinical Outcome in Non-Small-Cell Lung Cancer. NEJM
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Herbst, R. S., Lippman, S. M.
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Chin, T. M., Anuar, D., Soo, R., Salto-Tellez, M., Li, W. Q., Ahmad, B., Lee, S. C., Goh, B. C., Kawakami, K., Segal, A., Iacopetta, B., Soong, R.
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Sequist, L. V., Joshi, V. A., Janne, P. A., Muzikansky, A., Fidias, P., Meyerson, M., Haber, D. A., Kucherlapati, R., Johnson, B. E., Lynch, T. J.
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