Cancer Res Treat.  2018 Jul;50(3):908-916. 10.4143/crt.2017.378.

EGFR Mutation Status in Lung Adenocarcinoma-Associated Malignant Pleural Effusion and Efficacy of EGFR Tyrosine Kinase Inhibitors

Affiliations
  • 1Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea. sook3529@hanmail.net
  • 2Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea.
  • 3Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 4Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.

Abstract

PURPOSE
Malignant pleural effusions (MPEs) are often observed in lung cancer, particularly adenocarcinoma. The aim of this study was to investigate epidermal growth factor receptor (EGFR) mutation status in lung adenocarcinoma-associated MPEs (LA-MPEs) and its correlation with efficacy of EGFR tyrosine kinase inhibitor (TKI) therapy.
MATERIALS AND METHODS
Samples comprised 40 cell blocks of pathologically-confirmed LA-MPEs collected before the start of EGFR TKI therapy. EGFR mutation status was re-evaluated by peptide nucleic acid clamping and the clinical outcomes of EGFR TKI-treated patients were analyzed retrospectively.
RESULTS
EGFR mutations were detected in 72.5% of LA-MPE cell blocks (29/40). The median progression-free survival for patients with EGFR mutations in LA-MPEs was better than that for patients with wild-type EGFR (7.33 months vs. 2.07 months; hazard ratio, 0.486; 95% confidence interval, 0.206 to 1.144; p=0.032). The objective response rate (ORR) of 26 patients with EGFR mutations in LA-MPEs among the 36 patients with measurable lesions was 80.8%, while the ORR of the 10 patients with wild-type EGFR in LA-MPEs was 10% (p < 0.001). Among the 26 patients with EGFR mutations in LA-MPEs, the ORR of target lesions and LA-MPEs were 88.5% and 61.5%, respectively (p=0.026).
CONCLUSION
EGFR mutation status in cell blocks of LA-MPEs confirmed by pathologic diagnosis is highly predictive of EGFR TKI efficacy. For patients with EGFR mutations in LA-MPEs, the response to EGFR TKIs seems to be worse for pleural effusions than for solid tumors.

Keyword

Epidermal growth factor receptor; Lung adenocarcinoma; Pleural effusion; Tyrosine kinase inhibitor

MeSH Terms

Adenocarcinoma
Constriction
Diagnosis
Disease-Free Survival
Humans
Lung Neoplasms
Lung*
Pleural Effusion
Pleural Effusion, Malignant*
Protein-Tyrosine Kinases*
Receptor, Epidermal Growth Factor
Retrospective Studies
Tyrosine*
Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor
Tyrosine

Figure

  • Fig. 1. Flow diagram. MPE, malignant pleural effusion; EGFR TKI, epidermal growth factor receptor tyrosine kinase inhibitor.

  • Fig. 2. Progression-free survival according to EGFR mutation status in cell blocks of malignant pleural effusion. EGFR, epidermal growth factor receptor; WT, wildtype; MT, mutant-type; CI, confidence interval; HR, hazard ratio.


Reference

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