title: Clinical and testing protocols for the analysis of epidermal growth factor receptor mutations in East Asian patients with non-small cell lung cancer: a combined clinical-molecular pathological approach.
abstract: BACKGROUND
  Several randomized phase III studies in advanced stage non-small cell lung cancer (NSCLC) confirmed the superior response rate and progression-free survival of using epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor as first-line therapy compared with chemotherapy in patients with activating EGFR mutations. Despite the need for EGFR mutation tests to guide first-line therapy in East Asian NSCLC, there are no current standard clinical and testing protocols.
  
  
  METHODS
  A consensus meeting was held involving expert oncologists, pulmonologists, and pathologists to discuss the current status and variations in EGFR mutation testing of NSCLC across Asia and to recommend a standard clinical and laboratory testing approach for future use.
  
  
  RESULTS
  Currently, EGFR mutation tests are only routinely performed in some East Asian countries and medical centers. The consensus recommendation was to perform the test in all newly diagnosed patients with advanced stage nonsquamous lung cancer and some squamous patients with clinical features associated with higher prevalence of EGFR mutations. To increase the sensitivity and specificity of the EGFR mutation tests, tissue acquisition and pretest sample evaluation are important steps in addition to standardization of the EGFR mutation test methodology.
  
  
  CONCLUSIONS
  A standardized EGFR mutation testing protocol is an essential step toward realization of personalized medicine in East Asian NSCLC treatment.
authors.affiliation: Department of Pathology, National University Health System, Cancer Science Institute of Singapore, National University of Singapore, Singapore.
authors.forename: Manuel
authors.initials: M
authors.lastname: Salto-Tellez
authors.forename: Ming-Sound
authors.initials: MS
authors.lastname: Tsao
authors.forename: Jin-Yuan
authors.initials: JY
authors.lastname: Shih
authors.forename: Sumitra
authors.initials: S
authors.lastname: Thongprasert
authors.forename: Shun
authors.initials: S
authors.lastname: Lu
authors.forename: Gee-Chen
authors.initials: GC
authors.lastname: Chang
authors.forename: Joseph Siu-Kie
authors.initials: JS
authors.lastname: Au
authors.forename: Teh-Ying
authors.initials: TY
authors.lastname: Chou
authors.forename: Jong-Seok
authors.initials: JS
authors.lastname: Lee
authors.forename: Yuan-Kai
authors.initials: YK
authors.lastname: Shi
authors.forename: Ahmad
authors.initials: A
authors.lastname: Radzi
authors.forename: Jin-Hyoung
authors.initials: JH
authors.lastname: Kang
authors.forename: Sang-We
authors.initials: SW
authors.lastname: Kim
authors.forename: Soo-Yong
authors.initials: SY
authors.lastname: Tan
authors.forename: James Chih-Hsin
authors.initials: JC
authors.lastname: Yang
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D044466:Asian People / Q000235:genetics; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology*; D004252:DNA Mutational Analysis / Q000592:standards*; D019008:Drug Resistance, Neoplasm / Q000235:genetics*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000235:genetics*; D005202:Asia, Eastern; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000473:pathology; D009154:Mutation / Q000235:genetics*; D009367:Neoplasm Staging; D057089:Pathology, Molecular; D017410:Practice Guidelines as Topic / Q000592:standards*; D057285:Precision Medicine; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; C512478:EGFR protein, human; D066246:ErbB Receptors