What is EGFR-positive lung cancer and how is it treated?

What is EGFR and the EGFR gene?

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. The EGFR gene is responsible for providing a blueprint, so cells can create the EGFR protein on a cell’s surface, and an EGFR mutation (also known as a biomarker or tumor marker) 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 the EGFR gene causes the EGFR protein to remain stuck in the “on” position. This “drives” abnormal cell growth, which is what cancer is.

EGFR 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

Testing for the EGFR mutation

A blood biopsy is especially effective in detecting the presence of EGFR NSCLC and 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.

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. You should have this testing done and 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 diagnose the lung cancer.)

Remember These Important Points to Biomarker Testing

  • Follow the current guidelines recommended by The National Comprehensive Cancer Network (NCCN). These guidelines recommend that your tumor be tested for at least 8 different biomarkers.
  • Request this thorough biomarker testing from your physician, for the very best options for treatment.
  • Wait for all biopsy test results to be returned before starting a treatment.

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

Lung Cancer Testing FAQ

Where can I go for Comprehensive Biomarker Testing?

Your doctor will know where to send your tissue sample for comprehensive biomarker testing. NCI-Designated Comprehensive Cancer Centers and other academic centers and many community hospitals or medical centers have experience in comprehensive biomarker testing. You can also have the testing done by a commercial lab recommended by your physician.

What are the treatment options for EGFR-positive lung cancer?

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.

Many effective EGFR-positive treatments are available that have proven to be effective treatments 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. Some examples of Targeted Therapies that treat EGFR-positive lung cancer are:

  • Afatinib (Gilotrif)
  • Gefitinib (Iressa)
  • Erlotinib (Tarceva)
  • Osimertinib (Tagrisso)
  • Necitumumaab (Portrazza)
  • Dacomitinib (Vizimpro)

Many patients find that over time their cancer becomes resistant to the targeted therapy that they’re taking. This is why lung cancer research is so important so that when resistance happens, there is likely to be another treatment option available.

Are Clinical Trials an option?

Clinical trials are sometimes great options for patients with EGFR-positive lung cancer. If you are accepted into a clinical trial, you will either receive an investigational drug or be randomized to receive the investigational drug or the best standard of care, depending 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. You may receive a new treatment that might become a best option for you. Also note that there may also be additional expenses that might not be covered by the trial sponsor. So please read the Informed Consent agreement carefully. Discuss any concerns with a trial coordinator prior to making your decision.

How can I find a Clinical Trial?

Here are 2 ways to find clinical trials – working with your doctor, you might get a jump on a new and better treatment even before it is available to others. This can accelerate medical breakthroughs for everyone and helps to increase EGFR positive lung cancer life expectancy.

Search for Clinical Trials with Antidote Match™

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. And, medical breakthroughs are accelerated for everyone, helping to increase EGFR positive lung cancer life expectancy.

ClinicalTrials.gov image

Search for Clinical Trials at ClinicalTrials.gov

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

Is immunotherapy an option for EGFR-positive lung cancer?

Experts see that people with EGFR mutation positive lung cancer most often have immune systems that are already working well. This means that immunotherapy isn’t as helpful for EGFR as it is for other lung cancers where the immune system has been compromised. However, ongoing studies being conducted in this area show some promising results.

What About Combination Therapy as an EGFR-positive Treatment?

Combination therapy is the combined use of different treatment options to treat one disease and is an exciting new treatment option for EGFR-positive lung cancer. Although very new, it is showing some promise as an effective treatment for adult non small cell lung cancer (NSCLC) patients. One type of combination therapy combines an immunotherapy drug with specific chemotherapy drugs. Results are encouraging. Lung cancer patients who would benefit from combination therapy are:

  • patients who have not had treatment for their metastatic disease before
  • patients with an EGFR mutation or ALK-positive lung cancer who have failed on a previous targeted therapy

EGFR Lung Cancer Prognosis

“Nobody wants to have lung cancer. But, the truth is, that if you’re going to have lung cancer, EGFR lung cancer patients have the most hope, I think, of all patients with lung cancer. 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 to live better lives.”

~ Dr. Natasha Leighl, Princess Margaret Hospital, Toronto, CA
Photo of Natasha Leighl

HOPE

More people are living with lung cancer.

Follow the hopeful stories of EGFR-positive lung cancer survivors: Frank McKenna, Jill Feldman, and Ivy Elkins.

RESEARCH

Learn more about lung cancer with EGFR Mutation

Watch these Hope With Answers videos on the most current approved treatments for lung cancer patients with the EGFR mutation.

LIFE

New lung cancer research is saving more lives.

Stand with survivors and help fund lung cancer research. By donating to LCFA, you help to fund innovative new research in the field of lung cancer treatment.