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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Okabe, T., Okamoto, I., Tsukioka, S., Uchida, J., Iwasa, T., Yoshida, T., Hatashita, E., Yamada, Y., Satoh, T., Tamura, K., Fukuoka, M., Nakagawa, K.
(2008). Synergistic antitumor effect of S-1 and the epidermal growth factor receptor inhibitor gefitinib in non-small cell lung cancer cell lines: role of gefitinib-induced down-regulation of thymidylate synthase. Molecular Cancer Therapeutics
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Pinter, F., Papay, J., Almasi, A., Sapi, Z., Szabo, E., Kanya, M., Tamasi, A., Jori, B., Varkondi, E., Moldvay, J., Szondy, K., Keri, G., Dominici, M., Conte, P., Eckhardt, S., Kopper, L., Schwab, R., Petak, I.
(2008). Epidermal Growth Factor Receptor (EGFR) High Gene Copy Number and Activating Mutations in Lung Adenocarcinomas Are Not Consistently Accompanied by Positivity for EGFR Protein by Standard Immunohistochemistry. J. Mol. Diagn.
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Black, P. C., Brown, G. A., Inamoto, T., Shrader, M., Arora, A., Siefker-Radtke, A. O., Adam, L., Theodorescu, D., Wu, X., Munsell, M. F., Bar-Eli, M., McConkey, D. J., Dinney, C. P.N.
(2008). Sensitivity to Epidermal Growth Factor Receptor Inhibitor Requires E-Cadherin Expression in Urothelial Carcinoma Cells. Clin. Cancer Res.
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Burris, H. III, Rocha-Lima, C.
(2008). New Therapeutic Directions for Advanced Pancreatic Cancer: Targeting the Epidermal Growth Factor and Vascular Endothelial Growth Factor Pathways. The Oncologist
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Raponi, M., Lancet, J. E., Fan, H., Dossey, L., Lee, G., Gojo, I., Feldman, E. J., Gotlib, J., Morris, L. E., Greenberg, P. L., Wright, J. J., Harousseau, J.-L., Lowenberg, B., Stone, R. M., De Porre, P., Wang, Y., Karp, J. E.
(2008). A 2-gene classifier for predicting response to the farnesyltransferase inhibitor tipifarnib in acute myeloid leukemia. Blood
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Lilenbaum, R., Axelrod, R., Thomas, S., Dowlati, A., Seigel, L., Albert, D., Witt, K., Botkin, D.
(2008). Randomized Phase II Trial of Erlotinib or Standard Chemotherapy in Patients With Advanced Non-Small-Cell Lung Cancer and a Performance Status of 2. JCO
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Eberhard, D. A., Giaccone, G., Johnson, B. E.
(2008). Biomarkers of Response to Epidermal Growth Factor Receptor Inhibitors in Non-Small-Cell Lung Cancer Working Group: Standardization for Use in the Clinical Trial Setting. JCO
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Garcia, A. A.
(2008). Small Molecules: Big Changes in the Cancer Treatment Paradigm. Journal of Pharmacy Practice
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Bradbury, P. A., Heist, R. S., Kulke, M. H., Zhou, W., Marshall, A. L., Miller, D. P., Su, L., Park, S., Temel, J., Fidias, P., Sequist, L., Lynch, T. J., Wain, J. C., Shepherd, F. A., Christiani, D. C., Liu, G.
(2008). A Rapid Outcomes Ascertainment System Improves the Quality of Prognostic and Pharmacogenetic Outcomes from Observational Studies. Cancer Epidemiol. Biomarkers Prev.
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Duffy, A., Kortmansky, J., Schwartz, G. K., Capanu, M., Puleio, S., Minsky, B., Saltz, L., Kelsen, D. P., O'Reilly, E. M.
(2008). A phase I study of erlotinib in combination with gemcitabine and radiation in locally advanced, non-operable pancreatic adenocarcinoma. Ann Oncol
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de Marinis, F., Grossi, F.
(2008). Clinical Evidence for Second- and Third-Line Treatment Options in Advanced Non-Small Cell Lung Cancer. The Oncologist
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Butts, C. A., Bodkin, D., Middleman, E. L., Englund, C. W., Ellison, D., Alam, Y., Kreisman, H., Graze, P., Maher, J., Ross, H. J., Ellis, P. M., McNulty, W., Kaplan, E., Pautret, V., Weber, M. R., Shepherd, F. A.
(2007). Randomized Phase II Study of Gemcitabine Plus Cisplatin or Carboplatin, With or Without Cetuximab, As First-Line Therapy for Patients With Advanced or Metastatic Non-Small-Cell Lung Cancer. JCO
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Solit, D. B., Santos, E., Pratilas, C. A., Lobo, J., Moroz, M., Cai, S., Blasberg, R., Sebolt-Leopold, J., Larson, S., Rosen, N.
(2007). 3'-Deoxy-3'-[18F]Fluorothymidine Positron Emission Tomography Is a Sensitive Method for Imaging the Response of BRAF-Dependent Tumors to MEK Inhibition. Cancer Res.
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Holdsworth, C. H., Badawi, R. D., Manola, J. B., Kijewski, M. F., Israel, D. A., Demetri, G. D., Van den Abbeele, A. D.
(2007). CT and PET: Early Prognostic Indicators of Response to Imatinib Mesylate in Patients with Gastrointestinal Stromal Tumor. Am. J. Roentgenol.
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Thomas, F., Rochaix, P., Benlyazid, A., Sarini, J., Rives, M., Lefebvre, J. L., Allal, B. C., Courbon, F., Chatelut, E., Delord, J.-P.
(2007). Pilot Study of Neoadjuvant Treatment with Erlotinib in Nonmetastatic Head and Neck Squamous Cell Carcinoma. Clin. Cancer Res.
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Liu, W., Wu, X., Zhang, W., Montenegro, R. C., Fackenthal, D. L., Spitz, J. A., Huff, L. M., Innocenti, F., Das, S., Cook,, E. H. Jr., Cox, N. J., Bates, S. E., Ratain, M. J.
(2007). Relationship of EGFR Mutations, Expression, Amplification, and Polymorphisms to Epidermal Growth Factor Receptor Inhibitors in the NCI60 Cell Lines. Clin. Cancer Res.
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Wu, W., O'Reilly, M. S., Langley, R. R., Tsan, R. Z., Baker, C. H., Bekele, N., Tang, X. M., Onn, A., Fidler, I. J., Herbst, R. S.
(2007). Expression of epidermal growth factor (EGF)/transforming growth factor-{alpha} by human lung cancer cells determines their response to EGF receptor tyrosine kinase inhibition in the lungs of mice. Molecular Cancer Therapeutics
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Janne, P. A., von Pawel, J., Cohen, R. B., Crino, L., Butts, C. A., Olson, S. S., Eiseman, I. A., Chiappori, A. A., Yeap, B. Y., Lenehan, P. F., Dasse, K., Sheeran, M., Bonomi, P. D.
(2007). Multicenter, Randomized, Phase II Trial of CI-1033, an Irreversible Pan-ERBB Inhibitor, for Previously Treated Advanced Non Small-Cell Lung Cancer. JCO
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Arenberg, D.
(2007). Bronchioloalveolar Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest
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Ogino, A., Kitao, H., Hirano, S., Uchida, A., Ishiai, M., Kozuki, T., Takigawa, N., Takata, M., Kiura, K., Tanimoto, M.
(2007). Emergence of Epidermal Growth Factor Receptor T790M Mutation during Chronic Exposure to Gefitinib in a Non Small Cell Lung Cancer Cell Line. Cancer Res.
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Godin-Heymann, N., Bryant, I., Rivera, M. N., Ulkus, L., Bell, D. W., Riese, D. J. II, Settleman, J., Haber, D. A.
(2007). Oncogenic Activity of Epidermal Growth Factor Receptor Kinase Mutant Alleles Is Enhanced by the T790M Drug Resistance Mutation. Cancer Res.
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