Importance of Testing

Different EGFR mutations may occur at diagnosis and progression

EGFR mutations at diagnosis and progression
EGFR mutations at diagnosis and progression

First-line
Test for sensitizing EGFR mutations

According to ASCO and NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), newly diagnosed patients with mNSCLC should be tested for sensitizing EGFR mutations and, if positive, treated with an EGFR-TKI1-3

EGFR mutations at diagnosis and progression
EGFR mutations at diagnosis and progression

Monitor for progression

Patients receiving first-line therapy with 1st- or 2nd-generation EGFR-TKIs typically progress after 9 to 13 months of treatment4-8

EGFR mutations at diagnosis and progression
EGFR mutations at diagnosis and progression

Upon progression
Test for EGFR T790M

Upon progression while on an EGFR-TKI, NCCN Guidelines® recommend testing patients for the EGFR T790M mutation1

Sensitizing EGFR mutations are common in newly diagnosed patients with mNSCLC9,10

 

EGFR mutation prevalence at diagnosis9,10

EGFR mutation prevalence at diagnosis of metastatic non-small cell lung cancer (NSCLC)
EGFR mutation prevalence at diagnosis of metastatic non-small cell lung cancer (NSCLC)

The prevalence of sensitizing EGFR mutations varies by ethnicity: 7% to 23% in Western patients vs 30% to 50% in Asian patients.11-14

Sensitizing EGFR mutations are predictive of response to first-line EGFR-TKIs

Response icon
Response icon

Patients with EGFRm mNSCLC treated with first-line EGFR-TKIs in clinical trials had4-8,15:

  • Longer progression-free survival
  • Higher overall response rates

Patients with EGFRm mNSCLC are more likely to respond to EGFR-TKIs; therefore, identifying EGFR mutations is critical to inform treatment decisions.1,4-8,15

Patients may develop acquired resistance mutations in EGFR that drive progression16

Time to progression on 1st- or 2nd-generation EGFR-TKIs
Time to progression on 1st- or 2nd-generation EGFR-TKIs

EGFR T790M is the most common resistance mutation to develop upon progression with a 1st- or 2nd-generation EGFR-TKI.17-21

EGFR T790M mutation prevalence upon progression in metastatic non-small cell lung cancer (NSCLC)
EGFR T790M mutation prevalence upon progression in metastatic non-small cell lung cancer (NSCLC)

of patients who progressed on 1st- or 2nd-generation EGFR-TKIs developed an EGFR T790M resistance mutation.18-22

ASCO, American Society of Clinical Oncology; EGFR, epidermal growth factor receptor; EGFRm, EGFR mutation–positive; mNSCLC, metastatic non–small cell lung cancer; NCCN, National Comprehensive Cancer Network; TKI, tyrosine kinase inhibitor.

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

References: 1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non-Small Cell Lung Cancer V6.2018. © National Comprehensive Cancer Network, Inc. 2018. All rights reserved. Accessed September 27, 2018. To view the most recent and complete version of the guidelines, go online to NCCN.org. 2. Hanna N et al. J Clin Oncol. 2017;35(30):3484-3515. 3. Leighl NB et al. J Clin Oncol. 2014;32(32):3673-3679. 4. Wu YL et al. Lancet Oncol. 2014;15(2):213-222. 5. Rosell R et al. Lancet Oncol. 2012;13(3):239-246. 6. Mitsudomi T et al. Lancet Oncol. 2010;11(2):121-128. 7. Sequist LV et al. J Clin Oncol. 2013;31(27):3327-3334. 8. Zhou C et al. Lancet Oncol. 2011;12(8):735-742. 9. Sholl LM et al. J Thorac Oncol. 2015;10(5):768-777. 10. Sharma SV et al. Nat Rev Cancer. 2007;7(3):169-181. 11. Shi Y et al. J Thorac Oncol. 2014;9(2):154-162. 12. Sekine I et al. Br J Cancer. 2008;99(11):1757-1762. 13. Shigematsu H et al. J Natl Cancer Inst. 2005;97(5):339-346. 14. D'Angelo SP et al. J Clin Oncol. 2011;29(15):2066-2070. 15. Soria JC et al. N Engl J Med. 2018;378(2):113-125. 16. Sacher AG et al. Cancer. 2014;120(15):2289-2298. 17. Cortot AB et al. Eur Respir Rev. 2014;23:356-366. 18. Oxnard GR et al. Clin Cancer Res. 2011;17:1616-1622. 19. Sun JM et al. Lung Cancer. 2013;82:294-298. 20. Sequist LV et al. Sci Transl Med. 2011;3(75):75ra26. 21. Yu HA et al. Clin Cancer Res. 2013;19(8):2240-2247. 22. Wu SG et al. Oncotarget. 2016;7(11):12404-12413.