PMID- 15870435 OWN - NLM STAT- MEDLINE DCOM- 20050517 LR - 20220416 IS - 1460-2105 (Electronic) IS - 0027-8874 (Linking) VI - 97 IP - 9 DP - 2005 May 4 TI - Epidermal growth factor receptor gene and protein and gefitinib sensitivity in non-small-cell lung cancer. PG - 643-55 AB - 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. FAU - Cappuzzo, Federico AU - Cappuzzo F AD - University of Colorado Health Sciences Center and University of Colorado Cancer Center, Aurora, CO 80010, USA. FAU - Hirsch, Fred R AU - Hirsch FR FAU - Rossi, Elisa AU - Rossi E FAU - Bartolini, Stefania AU - Bartolini S FAU - Ceresoli, Giovanni L AU - Ceresoli GL FAU - Bemis, Lynne AU - Bemis L FAU - Haney, Jerry AU - Haney J FAU - Witta, Samir AU - Witta S FAU - Danenberg, Kathleen AU - Danenberg K FAU - Domenichini, Irene AU - Domenichini I FAU - Ludovini, Vienna AU - Ludovini V FAU - Magrini, Elisabetta AU - Magrini E FAU - Gregorc, Vanesa AU - Gregorc V FAU - Doglioni, Claudio AU - Doglioni C FAU - Sidoni, Angelo AU - Sidoni A FAU - Tonato, Maurizio AU - Tonato M FAU - Franklin, Wilbur A AU - Franklin WA FAU - Crino, Lucio AU - Crino L FAU - Bunn, Paul A Jr AU - Bunn PA Jr FAU - Varella-Garcia, Marileila AU - Varella-Garcia M LA - eng GR - 2P30-CA46934/CA/NCI NIH HHS/United States GR - P01-CA58187/CA/NCI NIH HHS/United States GR - U01-CA 85070/CA/NCI NIH HHS/United States PT - Clinical Trial PT - Comment PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - J Natl Cancer Inst JT - Journal of the National Cancer Institute JID - 7503089 RN - 0 (Antineoplastic Agents) RN - 0 (Biomarkers, Tumor) RN - 0 (Protein Kinase Inhibitors) RN - 0 (Proto-Oncogene Proteins) RN - 0 (Quinazolines) RN - EC 2.7.10.1 (ErbB Receptors) RN - EC 2.7.11.1 (AKT1 protein, human) RN - EC 2.7.11.1 (Protein Serine-Threonine Kinases) RN - EC 2.7.11.1 (Proto-Oncogene Proteins c-akt) RN - S65743JHBS (Gefitinib) SB - IM CIN - J Natl Cancer Inst. 2005 May 4;97(9):621-3. PMID: 15870427 CON - J Natl Cancer Inst. 2005 May 4;97(9):628-30. PMID: 15870431 MH - Adult MH - Aged MH - Antineoplastic Agents/*pharmacology MH - Biomarkers, Tumor/*metabolism MH - Carcinoma, Non-Small-Cell Lung/*drug therapy/metabolism MH - Disease-Free Survival MH - ErbB Receptors/*antagonists & inhibitors/*genetics MH - Female MH - Gefitinib MH - Gene Expression Regulation, Enzymologic MH - Gene Expression Regulation, Neoplastic MH - Humans MH - Immunohistochemistry MH - In Situ Hybridization, Fluorescence MH - Lung Neoplasms/*drug therapy/metabolism MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Predictive Value of Tests MH - Proportional Hazards Models MH - Protein Kinase Inhibitors/*pharmacology MH - Protein Serine-Threonine Kinases/drug effects/metabolism MH - Proto-Oncogene Proteins/drug effects/metabolism MH - Proto-Oncogene Proteins c-akt MH - Quinazolines/*pharmacology MH - Research Design MH - Reverse Transcriptase Polymerase Chain Reaction MH - Sequence Analysis, DNA MH - Survival Analysis EDAT- 2005/05/05 09:00 MHDA- 2005/05/18 09:00 CRDT- 2005/05/05 09:00 PHST- 2005/05/05 09:00 [pubmed] PHST- 2005/05/18 09:00 [medline] PHST- 2005/05/05 09:00 [entrez] AID - 97/9/643 [pii] AID - 10.1093/jnci/dji112 [doi] PST - ppublish SO - J Natl Cancer Inst. 2005 May 4;97(9):643-55. doi: 10.1093/jnci/dji112.