Consensus for EGFR mutation testing in non-small cell lung cancer: results from a European workshop.
BACKGROUND
Activating somatic mutations of the tyrosine kinase domain of epidermal growth factor receptor (EGFR) have recently been characterized in a subset of patients with advanced non-small cell lung cancer (NSCLC). Patients harboring these mutations in their tumors show excellent response to EGFR tyrosine kinase inhibitors (EGFR-TKIs). The EGFR-TKI gefitinib has been approved in Europe for the treatment of adult patients with locally advanced or metastatic NSCLC with activating mutations of the EGFR TK. Because EGFR mutation testing is not yet well established across Europe, biomarker-directed therapy only slowly emerges for the subset of NSCLC patients most likely to benefit: those with EGFR mutations.


METHODS
The "EGFR testing in NSCLC: from biology to clinical practice" International Association for the Study of Lung Cancer-European Thoracic Oncology Platform multidisciplinary workshop aimed at facilitating the implementation of EGFR mutation testing. Recommendations for high-quality EGFR mutation testing were formulated based on the opinion of the workshop expert group.


RESULTS
Co-operation and communication flow between the various disciplines was considered to be of most importance. Participants agreed that the decision to request EGFR mutation testing should be made by the treating physician, and results should be available within 7 working days. There was agreement on the importance of appropriate sampling techniques and the necessity for the standardization of tumor specimen handling including fixation. Although there was no consensus on which laboratory test should be preferred for clinical decision making, all stressed the importance of standardization and validation of these tests.


CONCLUSIONS
The recommendations of the workshop will help implement EGFR mutation testing in Europe and, thereby, optimize the use of EGFR-TKIs in clinical practice.
Pirker
Robert
R
Medical University of Vienna, Vienna, Austria. robert.pirker@meduniwien.ac.at
Herth
Felix J F
FJ
Kerr
Keith M
KM
Filipits
Martin
M
Taron
Miquel
M
Gandara
David
D
Hirsch
Fred R
FR
Grunenwald
Dominique
D
Popper
Helmut
H
Smit
Egbert
E
Dietel
Manfred
M
Marchetti
Antonio
A
Manegold
Christian
C
Schirmacher
Peter
P
Thomas
Michael
M
Rosell
Rafael
R
Cappuzzo
Federico
F
Stahel
Rolf
R
D014408:Biomarkers, Tumor / Q000235:genetics*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000235:genetics* / Q000628:therapy; D002986:Clinical Trials as Topic; D066246:ErbB Receptors / Q000235:genetics*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000628:therapy; D008403:Mass Screening; D009154:Mutation / Q000235:genetics*
D014408:Biomarkers, Tumor; C512478:EGFR protein, human; D066246:ErbB Receptors