title: EGFR FISH assay predicts for response to cetuximab in chemotherapy refractory colorectal cancer patients.
abstract: BACKGROUND
  Standardized conditions to distinguish subpopulations of colorectal cancer (CRC) patients more and less sensitive to cetuximab therapy remain undefined.
  
  
  METHODS
  We retrospectively analyzed epidermal growth factor receptor (EGFR) copy number by fluorescence in situ hybridization (FISH) in paraffin-embedded tumor blocks from 85 chemorefractory CRC patients treated with cetuximab. Results were analyzed according to different score systems previously reported in colorectal and lung cancers. The primary end point of the study was identification of the EGFR FISH score that best associates with response rate (RR).
  
  
  RESULTS
  Using receiver operating characteristic (ROC) analysis, the cut-off that best discriminated responders versus nonresponders to cetuximab was a mean of 2.92 EGFR gene copies per cell. This model showed sensitivity of 58.6% [95% confidence interval (CI) = 47.1-70.1) and specificity of 93.3% (95% CI = 80.6-100). EGFR FISH-positive patients (N = 43, 50.6%) had significantly higher RR (P = 0.0001) and significantly longer time to disease progression (P = 0.02) than EGFR FISH negative (N = 42, 49.4%). Other scoring systems resulted less accurate in discriminating patients with the highest likelihood of response to cetuximab therapy.
  
  
  CONCLUSIONS
  CRC patients with high EGFR gene copy number have an increased likelihood to respond to cetuximab therapy. Prospective clinical trials with a careful standardization of assay conditions and pattern interpretation are urgently needed.
authors.affiliation: Department of Medical Oncology, Istituto Clinico Humanitas IRCCS, Rozzano, Italy. federico.cappuzzo@humanitas.it
authors.forename: F
authors.initials: F
authors.lastname: Cappuzzo
authors.forename: G
authors.initials: G
authors.lastname: Finocchiaro
authors.forename: E
authors.initials: E
authors.lastname: Rossi
authors.forename: P A
authors.initials: PA
authors.lastname: Jänne
authors.forename: C
authors.initials: C
authors.lastname: Carnaghi
authors.forename: C
authors.initials: C
authors.lastname: Calandri
authors.forename: K
authors.initials: K
authors.lastname: Bencardino
authors.forename: C
authors.initials: C
authors.lastname: Ligorio
authors.forename: F
authors.initials: F
authors.lastname: Ciardiello
authors.forename: T
authors.initials: T
authors.lastname: Pressiani
authors.forename: A
authors.initials: A
authors.lastname: Destro
authors.forename: M
authors.initials: M
authors.lastname: Roncalli
authors.forename: L
authors.initials: L
authors.lastname: Crino
authors.forename: W A
authors.initials: WA
authors.lastname: Franklin
authors.forename: A
authors.initials: A
authors.lastname: Santoro
authors.forename: M
authors.initials: M
authors.lastname: Varella-Garcia
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000235:genetics; D000068818:Cetuximab; D015179:Colorectal Neoplasms / Q000737:chemistry* / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D016001:Confidence Intervals; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D066246:ErbB Receptors / Q000032:analysis* / Q000235:genetics; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D007558:Italy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D066246:ErbB Receptors; D000068818:Cetuximab