Cobas and Therascreen May Be Preferable Tests for EGFR Mutation

Testing for EGFR gene mutations in non-small cell lung cancer (NSCLC) helps identify patients who could benefit from treatment with EGFR-tyrosine kinase inhibitors (TKIs) like erlotinib (Tarceva), gefitinib (Iressa), or afatinib. However, there are no official recommendations for specific EGFR mutation tests. A study comparing three tests—cobas EGFR Mutation Test, Therascreen EGFR29 Mutation Kit, and 2× bidirectional Sanger sequencing—found that the cobas and Therascreen tests were more accurate and sensitive than Sanger sequencing. The cobas test required the smallest amount of tumor tissue, while the Sanger test can theoretically detect more types of mutations than the other tests.

Zolinza May Circumvent TKI Resistance in Some Lung Cancer Patients

Tyrosine kinase inhibitors (TKIs) like erlotinib (Tarceva) and gefitinib (Iressa) are effective treatments for many patients with non-small cell lung cancer (NSCLC) who have mutations in the EGFR gene. However, patients who also have a certain version of the BIM gene are resistant to TKIs. Vorinostat (Zolinza), a member of a family of drugs called histone deacetylase (HDAC) inhibitors, restored the antitumor activity of Iressa in EGFR-mutant NSCLC cells and in animal models of EGFR-mutant NSCLC that carried the resistant BIM version. Combining Zolinza with TKIs may therefore help circumvent TKI resistance in patients who have the resistant form of BIM.

Mutations in EGFR and KRAS Genes Do Not Predict Lung Cancer Outcome by Themselves

Non-small cell lung cancer (NSCLC) patients with mutations in the EGFR gene are likely to benefit from treatment with tyrosine kinase inhibitors (TKIs) like erlotinib (Tarceva) and gefitinib (Iressa), while KRAS mutations predict poor TKI response. A study of patients who were not taking TKIs and had stages I/II/III NSCLC that had been surgically removed found no difference in recurrence or survival between patients with or without EGFR or KRAS mutations. This finding suggests that, while EGFR and KRAS mutations are useful for identifying patients who may benefit from targeted treatments like TKIs, they do not predict overall clinical outcomes by themselves.


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Tarceva May Be More Effective in Advanced NSCLC When Combined with Other Targeted Therapies

An analysis of multiple clinical trials compared erlotinib (Tarceva) alone to combining Tarceva with other targeted therapies as second-line treatment for advanced non-small cell lung cancer (NSCLC). In the various trials, Tarceva was combined with bevacizumab (Avastin), bortezomib (Velcade), everolismus (Afinitor), sorafenib (Nexavar), sunitinib (Sutent), entinostat, tivantinib, and R1507. While combined therapy produced more side effects, it was more effective than Tarceva alone. Notably, the trials included many patients who had not been tested for mutations in the EGFR and KRAS genes. In patients who had EGFR mutations and/or lacked KRAS mutations, Tarceva alone tended to control cancer progression better than combined therapy, highlighting the importance of biomarker testing to identify which patients are most likely to benefit from different therapies.

FDA Approves Automated Scanning System for ALK Gene Mutations

Three percent to 5% of non-small cell lung cancer (NSCLC) patients have a mutation in the ALK gene and may benefit from treatment with critozinib (Xalkori). In 2011, the FDA approved a test that samples NSCLC tissue and highlights ALK mutations with a glowing tag. Now, the FDA has approved an automated scanning system, GenASIs Scan & Analysis, for examining these tagged tissue samples. The automated system, produced by Applied Spectral Imaging, promises fast, reliable detection of ALK mutations in NSCLC.

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Local Tumor Removal Followed by TKI Treatment May Be Effective in Lung Cancer Patients Resistant to TKIs

Many non-small cell lung cancer (NSCLC) patients who receive EGFR-tyrosine kinase inhibitors (TKIs) like erlotinib (Tarceva) and gefitinib (Iressa) develop drug resistance. Some of these patients may also have a small number of metastases (oligometastatic disease), which can be destroyed with local therapy. Local therapy methods include surgical removal, radiation, or electrical current produced by high-frequency radio waves (radiofrequency ablation). A recent study explored the use of local therapy, followed by renewed treatment with EGFR-TKIs, in patients with oligometastatic NSCLC who had become resistant to EGFR-TKIs. The treatment was well tolerated and effective, especially for patients in whom local therapy had removed all known tumors.

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Avastin-Containing Chemotherapy May Be Safe in Lung Cancer Patients with Brain Metastases

Bevacizumab (Avastin), which is approved for treatment of a number of advanced-stage cancer types, is commonly avoided in patients with brain metastases (cancer that has spread to the brain) because of fear of brain hemorrhages (bleeding in the brain). A retrospective study of 52 patients with advanced non-small cell lung cancer (NSCLC) who had received chemotherapy containing Avastin found no cases of serious bleeding events and no significant differences in survival or treatment side effects between patients with or without brain metastases. Avastin may therefore be a safe treatment option in NSCLC with brain metastases.

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Overexpression of IGF1R and EGFR Genes May Worsen Lung Cancer Prognosis

The roles of the genes IGF1R and EGFR in lung cancer were examined in patients with non-small cell lung cancer (NSCLC) who had their primary tumor surgically removed. Patients whose tumors had increased expression of both IGFR1R and EGFR were more likely to experience recurrence of the cancer after a shorter amount of time and had shorter survival times after surgery. This finding suggests that concurrent overexpression of IGF1R and EGFR is a negative prognosis factor in NSCLC and may indicate patients who are more likely to benefit from novel treatments with IGF1R inhibitors.

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Study Suggests Iressa Effective for Elderly Patients with EGFR-Mutant Lung Cancer

A retrospective study in Japan examined 55 patients aged 75 years or over with inoperable non-small cell lung cancer (NSCLC) who had a mutation in the EGFR gene and received gefitinib (Iressa) as first-line therapy. The treatment was generally well tolerated and patients experienced longer periods without cancer progression (median: 13.8 months) and longer overall survival (median: 29.1 months) than commonly reported for similar patients. While studies using control groups will need to confirm that Iressa is indeed more effective than standard chemotherapy or a placebo, these findings suggest that Iressa may be a preferable first-line treatment in elderly patients with advanced EGFR-mutant NSCLC.

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