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About Lung Cancer | Diagnosis | Biomarkers

EGFR

EGFR stands for Epidermal Growth Factor Receptor. EGFR is a protein expressed on the surface of cells. It is most commonly found on cells on the skin, although it can be found elsewhere in the body. An EGFR mutation (or biomarker) can negatively affect how the EGFR protein functions.

How the EGFR Mutation Works

EGFR’s job is to help cells grow and divide. In the case of EGFR-positive non small cell lung cancer (NSCLC), a mutation, or damage, in a gene causes the EGFR to remain stuck in the “on” position. This “drives” abnormal cell growth, which is what cancer is.

The EGFR biomarker is important in many cancers, including lung cancer. It was the first biomarker identified as a potential “target” for personalized treatments in lung cancer. EGFR-positive lung cancer is more common in certain populations, such as:

  • people who have never smoked or only smoked a little.
  • people with lung adenocarcinoma
  • women
  • young adults with lung cancer (EGFR mutations are present in roughly 50 percent of lung cancers in young adults).
  • people of Asian or East Asian heritage

 

In this EGFR-positive lung cancer video you will learn the answer to these questions:

What does EGFR mean?

What does having an EGFR biomarker present mean for lung cancer patients?

How common is EGFR-positive lung cancer?

What does all this mean for treatments for EGFR-positive lung cancer patients?

Testing for the EGFR Mutation

Comprehensive biomarker testing can determine whether an EGFR lung cancer mutation or another lung cancer mutation is present. If you receive a lung cancer diagnosis, the very first thing you should do is make sure your doctors have ordered comprehensive biomarker testing done on your lung cancer tumor. In addition to having this key testing done, you should have the results before starting any treatment, including chemo and/or immunotherapy.

The comprehensive biomarker testing will involve a biopsy of your lung cancer. This biopsy removes tissue. The tissue is then tested for its genetic makeup, or biomarkers. In most cases, biomarker testing can use the same tissue that was obtained during the original biopsy.  (The biopsy which was used to diagnosing the lung cancer.)

Remember These Important Points to Biomarker Testing

A blood biopsy is especially effective in detecting the presence of EGFR NSCLC. This biopsy can be performed before comprehensive biomarker testing. If the blood biopsy shows positive for an EGFR mutation, then the patient can be started on an EGFR inhibitor.

But, in all other instances, it is important to have comprehensive biomarker testing.

NCI-Designated Comprehensive Cancer Centers and other academic centers are excellent choices for and have experience in comprehensive biomarker testing. You can also have the testing done by a commercial lab recommended by your physician.

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Could My Kids Inherit My EGFR-Positive Lung Cancer?

In this EGFR-positive lung cancer video you will learn the answer to these questions:

  • What are the treatment options for EGFR-Positive lung cancer?
  • Could my kids inherit it?
  • What about immunotherapy?

Treatment Options

Once the biomarker testing is complete, and EGFR-positive lung cancer determined, there are many treatment options available. If your lung cancer hasn’t yet spread and it’s in an early stage, you might be a candidate for surgery to have the lung cancer completely removed. If not, the lung cancer can be treated with a targeted therapy, which is commonly a pill, taken by mouth.

Treatment Options

  • Targeted Therapies

    Many EGFR-positive treatments are available that have proven to be effective for many patients. These targeted therapies have been approved by the FDA for EGFR-positive lung cancer. Drugs called EGFR inhibitors can block (or target) the signal from EGFR that tells the cells to grow.

  • Immunotherapy

    People with EGFR mutation-positive lung cancer often have immune systems that are working well. So immunotherapy isn’t as helpful as it is for other lung cancers where the immune system has been compromised. Research is ongoing in immunotherapy for EGFR-positive lung cancer patients, and these studies show some promising results.

  • Combination Therapy

    Although new, it is showing promise as an effective treatment for adult non-small cell lung cancer (NSCLC) patients. One type combines an immunotherapy drug with specific chemotherapy drugs. The results are encouraging. People who would benefit from combination therapy are: patients who have not had treatment for their metastatic disease before and patients with an EGFR mutation or ALK-positive lung cancer who have failed on a previous targeted therapy.

FDA-Approved EGFR-Positive Lung Cancer Treatments

Types

  • Ramucirumab (Cyramza)

    Non-small cell lung cancer that has metastasized. It is used:
    With erlotinib hydrochloride as first-line therapy in patients whose disease has certain mutations in the EGFR gene. With docetaxel in patients whose disease has gotten worse during or after treatment with platinum chemotherapy. For patients whose disease has a mutation in the EGFR gene or ALK gene, ramucirumab is used if their disease has gotten worse after treatment with FDA-approved therapy for these mutations.

    Approved for: NSCLC

    Biomarkers: ALK, EGFR

    FDA Approval Date: 12/22/2024

    Used in: Targeted Therapy

  • Afatinib (Gilotrif)

    Non-small cell lung cancer (NSCLC) that has metastasized (spread to other parts of the body). It is used:
    As first-line treatment in patients with tumors that have certain EGFR gene mutations.

    Approved for: NSCLC

    Biomarkers: EGFR

    FDA Approval Date: 12/22/2024

    Used in: Targeted Therapy

  • Dacomitinib (Vizimpro)

    Non-small cell lung cancer (NSCLC) that has metastasized (spread to other parts of the body). It is used as first-line treatment in patients whose tumors have certain EGFR gene mutations.

    Approved for: NSCLC

    Biomarkers: EGFR

    FDA Approval Date: 12/22/2024

    Used in: Targeted Therapy

  • Gefitinib (Iressa)

    Gefitinib, marketed as Iressa, is a targeted therapy used primarily for treating non-small cell lung cancer (NSCLC) in patients with specific genetic mutations. The FDA first approved gefitinib in 2003 for patients with advanced NSCLC whose tumors express the epidermal growth factor receptor (EGFR) mutation. This targeted therapy works by inhibiting the EGFR pathway, which is often overactive in certain types of lung cancer, leading to reduced tumor growth. Gefitinib is commonly used as a first-line treatment for patients with EGFR-mutant NSCLC. Additionally, it can be used in patients whose disease has progressed after other treatments, offering another option for managing advanced lung cancer.

    Approved for: NSCLC

    Biomarkers: EGFR

    FDA Approval Date: 01/01/2003

    Used in: Targeted Therapy

  • Erlotinib (Tarceva)

    Erlotinib, marketed as Tarceva, is a targeted therapy primarily used to treat non-small cell lung cancer (NSCLC), particularly in patients with specific genetic mutations. The FDA first approved erlotinib in 2004 for the treatment of advanced NSCLC in patients who had previously received at least one chemotherapy regimen. Erlotinib works by inhibiting the epidermal growth factor receptor (EGFR), which is often mutated in NSCLC, leading to reduced tumor growth and improved patient outcomes. It is commonly used as a first-line treatment for patients with EGFR-mutant NSCLC and can also be an effective second-line option for those whose disease has progressed after chemotherapy. Additionally, erlotinib is sometimes used in combination with other therapies, such as chemotherapy or targeted treatments, enhancing its effectiveness in managing advanced lung cancer. Its targeted approach emphasizes the importance of genetic testing in personalizing lung cancer treatment strategies.

    Approved for: NSCLC

    Biomarkers: EGFR

    FDA Approval Date: 01/17/2024

    Used in: Combination Therapy, Targeted Therapy

Clinical Trials

Clinical trials are sometimes great options for patients with EGFR-positive lung cancer. If you are accepted into a clinical trial, you will be assigned to a treatment group. You will either receive an investigational drug or you will be randomized to receive the investigational drug or the best standard of care. The specifics of the clinical trial depend on whether you are in a first-in-human trial or a later phase trial. (Best standard of care is the best treatment that physicians are offering patients with that cancer.)

In addition, the care that is included in the clinical trial will be covered financially by the trial sponsor, and you may receive a new treatment that might become a best option for you. There may also be additional expenses that might not be covered by the trial sponsor, so please carefully read the Informed Consent agreement. Discuss any concerns with a trial coordinator prior to making your decision.

Antidote Match™ connects people with medical research studies, in the fastest and easiest way possible. All you need to do is answer a few questions, and they will find the right trials for you. You gain access to the latest medical developments and world-class care.

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ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world.

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  • Dr. Natasha Leighl

    If you’re going to have lung cancer, EGFR lung cancer patients have the most hope, I think. It means that people with EGFR-positive lung cancer have a real chance to have targeted therapies, to avoid chemotherapy, and to live longer and better lives.

    Dr. Natasha Leighl, Princess Margaret Hospital, Toronto, CA