Chemotherapy versus EGFR-targeted therapy in non-EGFR-mutated lung cancer

This article evaluated best treatment options for wild-type epidermal growth factor receptor (EGFR) lung cancer. Specifically, it compared outcomes using EGFR-targeted drugs versus conventional chemotherapy.

The EGFR gene is responsible for building a specific protein needed by cancer cells to multiply. Mutations (changes) in this gene increase cancer growth rates. However, these mutations also make cancer more responsive to treatments with drugs that specifically target EGFR. These are called EGFR-targeted therapies, and often include tyrosine kinase inhibitors (TKIs) such as erlotinib (Tarceva) and gefitinib (Iressa).

Wild-type EGFR lung cancer features cells in which no mutation can be identified in the EGFR gene. These tumor cells still produce the same protein needed for cancer growth, but in smaller quantities. Thus, EGFR wild-type tumors are assumed as non-responsive to EGFR targeted therapies.

This study presented an analysis of data derived from 11 previously published trials comparing chemotherapy versus EGFR-targeted TKIs. The analysis focused on 1605 patients with wild-type EGFR to determine which therapy yielded the best outcomes.

Results showed that in this specific patient group (wild-type EGFR, or without known EGFR mutations), progression-free survival (survival time without further cancer progression) was significantly increased with conventional chemotherapy compared to TKI therapy. Rates of tumor response to treatment were also significantly greater among patients receiving conventional chemotherapy. However, overall survival was similar among patients treated with chemotherapy compared to those treated with TKIs.

This analysis concluded that in patients without known EGFR mutations, standard chemotherapy provides improved tumor response rates and increased progression-free survival compared to EGFR-targeted biological therapies. However, patient overall survival was similar between the two treatment groups, indicating a need for new therapeutic avenues for patients without known genetic mutations.

The development of new laboratory techniques constantly increases the ability to identify previously unknown EGFR mutations.

Consult with your physician on the importance of genetic profiling in determining best treatment options for non-small cell lung cancer.