title: Epidermal growth factor receptor gene and protein and gefitinib sensitivity in non-small-cell lung cancer.
abstract: BACKGROUND
  Gefitinib is a selective inhibitor of the epidermal growth factor (EGFR) tyrosine kinase, which is overexpressed in many cancers, including non-small-cell lung cancer (NSCLC). We carried out a clinical study to compare the relationship between EGFR gene copy number, EGFR protein expression, EGFR mutations, and Akt activation status as predictive markers for gefitinib therapy in advanced NSCLC.
  
  
  METHODS
  Tumors from 102 NSCLC patients treated daily with 250 mg of gefitinib were evaluated for EGFR status by fluorescence in situ hybridization (FISH), DNA sequencing, and immunohistochemistry and for Akt activation status (phospho-Akt [P-Akt]) by immunohistochemistry. Time to progression, overall survival, and 95% confidence intervals (CIs) were calculated and evaluated by the Kaplan-Meier method; groups were compared using the log-rank test. Risk factors associated with survival were evaluated using Cox proportional hazards regression modeling and multivariable analysis. All statistical tests were two-sided.
  
  
  RESULTS
  Amplification or high polysomy of the EGFR gene (seen in 33 of 102 patients) and high protein expression (seen in 58 of 98 patients) were statistically significantly associated with better response (36% versus 3%, mean difference = 34%, 95% CI = 16.6 to 50.3; P<.001), disease control rate (67% versus 26%, mean difference = 40.6%, 95% CI = 21.5 to 59.7; P<.001), time to progression (9.0 versus 2.5 months, mean difference = 6.5 months, 95% CI = 2.8 to 10.3; P<.001), and survival (18.7 versus 7.0 months, mean difference = 11.7 months, 95% CI = 2.1 to 21.4; P = .03). EGFR mutations (seen in 15 of 89 patients) were also statistically significantly related to response and time to progression, but the association with survival was not statistically significant, and 40% of the patients with mutation had progressive disease. In multivariable analysis, only high EGFR gene copy number remained statistically significantly associated with better survival (hazard ratio = 0.44, 95% CI = 0.23 to 0.82). Independent of EGFR assessment method, EGFR+/P-Akt+ patients had a statistically significantly better outcome than EGFR-, P-Akt-, or EGFR+/P-Akt- patients.
  
  
  CONCLUSIONS
  High EGFR gene copy number identified by FISH may be an effective molecular predictor for gefitinib efficacy in advanced NSCLC.
authors.affiliation: University of Colorado Health Sciences Center and University of Colorado Cancer Center, Aurora, CO 80010, USA.
authors.forename: Federico
authors.initials: F
authors.lastname: Cappuzzo
authors.forename: Fred R
authors.initials: FR
authors.lastname: Hirsch
authors.forename: Elisa
authors.initials: E
authors.lastname: Rossi
authors.forename: Stefania
authors.initials: S
authors.lastname: Bartolini
authors.forename: Giovanni L
authors.initials: GL
authors.lastname: Ceresoli
authors.forename: Lynne
authors.initials: L
authors.lastname: Bemis
authors.forename: Jerry
authors.initials: J
authors.lastname: Haney
authors.forename: Samir
authors.initials: S
authors.lastname: Witta
authors.forename: Kathleen
authors.initials: K
authors.lastname: Danenberg
authors.forename: Irene
authors.initials: I
authors.lastname: Domenichini
authors.forename: Vienna
authors.initials: V
authors.lastname: Ludovini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Magrini
authors.forename: Vanesa
authors.initials: V
authors.lastname: Gregorc
authors.forename: Claudio
authors.initials: C
authors.lastname: Doglioni
authors.forename: Angelo
authors.initials: A
authors.lastname: Sidoni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tonato
authors.forename: Wilbur A
authors.initials: WA
authors.lastname: Franklin
authors.forename: Lucio
authors.initials: L
authors.lastname: Crino
authors.forename: Paul A
authors.initials: PA
authors.lastname: Bunn
authors.forename: Marileila
authors.initials: M
authors.lastname: Varella-Garcia
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000494:pharmacology*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000378:metabolism; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000235:genetics*; D005260:Female; D000077156:Gefitinib; D015971:Gene Expression Regulation, Enzymologic; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D047428:Protein Kinase Inhibitors / Q000494:pharmacology*; D017346:Protein Serine-Threonine Kinases / Q000187:drug effects / Q000378:metabolism; D011518:Proto-Oncogene Proteins / Q000187:drug effects / Q000378:metabolism; D051057:Proto-Oncogene Proteins c-akt; D011799:Quinazolines / Q000494:pharmacology*; D012107:Research Design; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D047428:Protein Kinase Inhibitors; D011518:Proto-Oncogene Proteins; D011799:Quinazolines; D066246:ErbB Receptors; C494918:AKT1 protein, human; D017346:Protein Serine-Threonine Kinases; D051057:Proto-Oncogene Proteins c-akt; D000077156:Gefitinib