Abstract
Background
There are many complex and rare mutations in the epidermal growth factor receptor (EGFR) gene in non-small cell lung cancer (NSCLC) other than the two classical mutations of L858R and exon 19 deletional mutation. The purpose of this study was to investigate the clinical significance of rare and complex mutations, and the efficacy of EGFR tyrosine kinase inhibitors (TKIs).
Methods
We analyzed 1,431 NSCLC patients who were treated with either gefitinib or erlotinib. Exons 18 to 21 of EGFR were analyzed by PCR and subjected to direct sequencing methods.
Results
Of 306 patients who had EGFR mutation, 24 patients (7.3 %) had complex mutations. The frequency of rare mutations was 10.3 %. Four groups were categorized [group A (N = 269): classical mutation alone; group B (N = 16): complex mutation with classical mutation; group C (N = 16): rare mutation alone or complex mutation with rare mutation; group D (N = 5); classical mutation with T790M]; the response rate (RR) to TKI was significantly different between each group (RR = 74.8 % in group A vs. 68.8 % in group B vs. 25.0 % in group C vs. 80.0 % in group D, P < 0.001). Progression-free survival (PFS) was also poorer in rare mutations (median PFS: 11.9 vs. 8.1 vs. 1.4 vs. 8.0 months, respectively, P < 0.001).
Conclusions
NSCLC patients harboring rare mutations did not show consistent and favorable responses to EGFR TKI compared with those harboring classical mutations. However, complex mutations with classical mutations showed similar treatment efficacy toward EGFR TKI to that with classical mutations alone.
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Acknowledgments
This work was supported by a National Research Foundation of Korea (NRF) Grant funded by the Korean Government (2010-0009563). We especially thank to our database manager Ju Yon Kim for her accurate data management. We also thank the members of Seoul National University Hospital Lung Study Group. This study was presented in part at the 48th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, June 1–5, 2012.
Conflict of interest
The authors declare that they have no conflict of interest.
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Keam, B., Kim, DW., Park, J.H. et al. Rare and complex mutations of epidermal growth factor receptor, and efficacy of tyrosine kinase inhibitor in patients with non-small cell lung cancer. Int J Clin Oncol 19, 594–600 (2014). https://doi.org/10.1007/s10147-013-0602-1
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DOI: https://doi.org/10.1007/s10147-013-0602-1