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Originally published as JCO Early Release 10.1200/JCO.2005.07.799 on March 14 2005

Journal of Clinical Oncology, Vol 23, No 11 (April 10), 2005: pp. 2556-2568
© 2005 American Society of Clinical Oncology.

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REVIEW ARTICLE

Epidermal Growth Factor Receptor Mutations, Small-Molecule Kinase Inhibitors, and Non–Small-Cell Lung Cancer: Current Knowledge and Future Directions

William Pao, Vincent A. Miller

From the Program in Cancer Biology and Genetics and the Thoracic Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center; and Weill Medical College of Cornell University, New York, NY

Address reprint requests to William Pao, MD, PhD, Varmus Lab—Box 62, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021; email: paow{at}mskcc.org.

PURPOSE: Gefitinib and erlotinib are small molecules that selectively inhibit epidermal growth factor receptor (EGFR) tyrosine kinase activity. When these drugs were introduced into the clinic, the specific targets affected in human tumors were unknown. In April 2004, two groups reported that mutations in the tyrosine kinase domain of EGFR are strongly associated with gefitinib sensitivity in patients with non–small-cell lung cancer (NSCLC). We subsequently extended these findings and showed that such mutations are also associated with sensitivity to erlotinib. Here, we present current knowledge about EGFR mutations in the context of clinical trials involving gefitinib and erlotinib in NSCLC.

DESIGN: This article reviews the rationale for targeting EGFR, the development of gefitinib and erlotinib, the discovery of EGFR mutations, and subsequent studies to define the incidence, spectrum, and functions of EGFR mutations.

RESULTS: The discovery of EGFR mutations promises to alter the ways in which we consider and treat NSCLC.

CONCLUSION: This information can guide practitioners and help them inform their patients about EGFR mutations and their impact on the treatment of NSCLC.

W.P. is supported by the CHEST and LUNGevity Foundation Clinical Research Award in Lung Cancer 2004.

Terms in blue are defined in the glossary, found at the end of this issue and online at www.jco.org.

Authors' disclosures of potential conflicts of interest are found at the end of this article.


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R. Wild, K. Fager, C. Flefleh, D. Kan, I. Inigo, S. Castaneda, F. Luo, A. Camuso, K. McGlinchey, and W. C. Rose
Cetuximab preclinical antitumor activity (monotherapy and combination based) is not predicted by relative total or activated epidermal growth factor receptor tumor expression levels
Mol. Cancer Ther., January 1, 2006; 5(1): 104 - 113.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
R. L. Yauch, T. Januario, D. A. Eberhard, G. Cavet, W. Zhu, L. Fu, T. Q. Pham, R. Soriano, J. Stinson, S. Seshagiri, et al.
Epithelial versus Mesenchymal Phenotype Determines In vitro Sensitivity and Predicts Clinical Activity of Erlotinib in Lung Cancer Patients
Clin. Cancer Res., December 15, 2005; 11(24): 8686 - 8698.
[Abstract] [Full Text] [PDF]


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J. Pharmacol. Exp. Ther.Home page
A. Arora and E. M. Scholar
Role of Tyrosine Kinase Inhibitors in Cancer Therapy
J. Pharmacol. Exp. Ther., December 1, 2005; 315(3): 971 - 979.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
E. B. Haura, Z. Zheng, L. Song, A. Cantor, and G. Bepler
Activated Epidermal Growth Factor Receptor-Stat-3 Signaling Promotes Tumor Survival In vivo in Non-Small Cell Lung Cancer
Clin. Cancer Res., December 1, 2005; 11(23): 8288 - 8294.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
E. E.W. Cohen, M. A. Kane, M. A. List, B. E. Brockstein, B. Mehrotra, D. Huo, A. M. Mauer, C. Pierce, A. Dekker, and E. E. Vokes
Phase II Trial of Gefitinib 250 mg Daily in Patients with Recurrent and/or Metastatic Squamous Cell Carcinoma of the Head and Neck
Clin. Cancer Res., December 1, 2005; 11(23): 8418 - 8424.
[Abstract] [Full Text] [PDF]


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Ann OncolHome page
M. Moroni, A. Sartore-Bianchi, S. Benvenuti, S. Artale, A. Bardelli, and S. Siena
Somatic mutation of EGFR catalytic domain and treatment with gefitinib in colorectal cancer
Ann. Onc., November 1, 2005; 16(11): 1848 - 1849.
[Full Text] [PDF]


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NEJMHome page
C. Nabhan, J. D. Bitran, T. Takano, Y. Ohe, W. Pao, M. Ladanyi, V. A. Miller, the Lung Cancer Oncogenome Group, F. A. Shepherd, L. Seymour, et al.
Erlotinib in lung cancer.
N. Engl. J. Med., October 20, 2005; 353(16): 1739 - 1741.
[Full Text] [PDF]


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JCOHome page
R. A. Walgren, M. A. Meucci, and H. L. McLeod
Pharmacogenomic Discovery Approaches: Will the Real Genes Please Stand Up?
J. Clin. Oncol., October 10, 2005; 23(29): 7342 - 7349.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
M. G. Kris
How Today's Developments in the Treatment of Non-Small Cell Lung Cancer Will Change Tomorrow's Standards of Care
Oncologist, October 1, 2005; 10(suppl_2): 23 - 29.
[Abstract] [Full Text] [PDF]


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JCOHome page
B. Movsas
Will Future Progress in Non-Small-Cell Lung Cancer Be Step by Step ... or by Leaps and Bounds?
J. Clin. Oncol., September 1, 2005; 23(25): 5859 - 5861.
[Full Text] [PDF]


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The OncologistHome page
W. S. Siegel-Lakhai, J. H. Beijnen, and J. H.M. Schellens
Current Knowledge and Future Directions of the Selective Epidermal Growth Factor Receptor Inhibitors Erlotinib (Tarceva(R)) and Gefitinib (Iressa(R))
Oncologist, September 1, 2005; 10(8): 579 - 589.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
T. Wasil and S. M. Lichtman
Clinical Pharmacology Issues Relevant to the Dosing and Toxicity of Chemotherapy Drugs in the Elderly
Oncologist, September 1, 2005; 10(8): 602 - 612.
[Abstract] [Full Text] [PDF]


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J. Mol. Diagn.Home page
Q. Pan, W. Pao, and M. Ladanyi
Rapid Polymerase Chain Reaction-Based Detection of Epidermal Growth Factor Receptor Gene Mutations in Lung Adenocarcinomas
J. Mol. Diagn., August 1, 2005; 7(3): 396 - 403.
[Abstract] [Full Text] [PDF]


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NEJMHome page
J. H. Doroshow
Targeting EGFR in Non-Small-Cell Lung Cancer
N. Engl. J. Med., July 14, 2005; 353(2): 200 - 202.
[Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
G. Tonon, K.-K. Wong, G. Maulik, C. Brennan, B. Feng, Y. Zhang, D. B. Khatry, A. Protopopov, M. J. You, A. J. Aguirre, et al.
High-resolution genomic profiles of human lung cancer
PNAS, July 5, 2005; 102(27): 9625 - 9630.
[Abstract] [Full Text] [PDF]


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JCOHome page
J. Baselga and C. L. Arteaga
Critical Update and Emerging Trends in Epidermal Growth Factor Receptor Targeting in Cancer
J. Clin. Oncol., April 10, 2005; 23(11): 2445 - 2459.
[Abstract] [Full Text] [PDF]


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Cold Spring Harb Symp Quant BiolHome page
H. VARMUS, W. PAO, K. POLITI, K. PODSYPANINA, and Y.-C.N. DU
Oncogenes Come of Age
Cold Spring Harb Symp Quant Biol, January 1, 2005; 70(0): 1 - 9.
[Abstract] [PDF]


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Cold Spring Harb Symp Quant BiolHome page
L.C. AMLER, A.D. GODDARD, and K.J. HILLAN
Predicting Clinical Benefit in Non-Small-Cell Lung Cancer Patients Treated with Epidermal Growth Factor Tyrosine Kinase Inhibitors
Cold Spring Harb Symp Quant Biol, January 1, 2005; 70(0): 483 - 488.
[Abstract] [PDF]



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