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Journal of Clinical Oncology, Vol 22, No 6 (March 15), 2004: pp. 1103-1109
© 2004 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2004.08.158

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Bronchioloalveolar Pathologic Subtype and Smoking History Predict Sensitivity to Gefitinib in Advanced Non–Small-Cell Lung Cancer

Vincent A. Miller, Mark G. Kris, Neelam Shah, Jyoti Patel, Christopher Azzoli, Jorge Gomez, Lee M. Krug, William Pao, Naiyer Rizvi, Barbara Pizzo, Leslie Tyson, Ennapadam Venkatraman, Leah Ben-Porat, Natalie Memoli, Maureen Zakowski, Valerie Rusch, Robert T. Heelan

From the Thoracic Oncology Service, Departments of Medicine, Biostatistics, Pathology, Surgery, and Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.

Address reprint requests to Vincent A. Miller, MD, Thoracic Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; e-mail: millerv{at}mskcc.org


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 Authors' Disclosures of...
 REFERENCES
 
PURPOSE: Gefitinib, an inhibitor of the epidermal growth factor receptor tyrosine kinase, induces radiographic regressions and symptomatic improvement in patients with non–small-cell lung cancer (NSCLC). Phase II trials suggested female sex and adenocarcinoma were associated with response. We undertook this analysis to identify additional clinical and pathologic features associated with sensitivity to gefitinib.

PATIENTS AND METHODS: We reviewed medical records, pathologic material, and imaging studies of all 139 NSCLC patients treated on one of three consecutive studies of gefitinib monotherapy performed at our institution. We identified patients experiencing a major objective response and compared their clinical and pathologic features with the others. Univariate and multivariable analyses were performed on potential predictive features associated with sensitivity to gefitinib.

RESULTS: Of 139 patients, 21 (15%; 95% CI, 9% to 21%), experienced a partial radiographic response. Variables identified as significant in univariate analysis included adenocarcinoma versus other NSCLC (19% v 0%; P = .004), adenocarcinoma with bronchioloalveolar features versus other adenocarcinomas (38% v 14%; P < .001), never smoker status versus former/current (36% v 8%; P < .001), and Karnofsky performance status >= 80% versus <= 70% (22% v 8%; P = .03). Multivariable analysis revealed the presence of adenocarcinoma with any bronchioloalveolar features (P = .004) and being a never smoker (P = .006) were independent predictors of response.

CONCLUSION: Our data suggest that individuals in whom gefitinib is efficacious are more likely to have adenocarcinomas of the bronchioloalveolar subtype and to be never smokers. These observations may provide clues to mechanisms determining sensitivity to this agent and suggest that NSCLC has a different biology in patients who never smoked and those with bronchioloalveolar carcinoma.


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 Authors' Disclosures of...
 REFERENCES
 
The epidermal growth factor receptor (EGFR) and its family members, ligands, and downstream effectors have emerged as leading targets in treating non–small-cell lung cancer (NSCLC). Activation of the EGFR by ligand binding or mutation stimulates cellular growth, proliferation, invasion, and metastasis and inhibits apoptosis [1]. Therefore, blockade of EGFR-mediated effects should theoretically arrest the growth of NSCLCs driven by EGFR signaling.

Gefitinib is a synthetic anilinoquinazoline that inhibits the EGFR tyrosine kinase in vitro with an concentration that inhibits 50% of 0.027 to 0.33 µmol/L, which is 100 times lower than the concentration required to block the kinases of HER-2, KDR, MEK-1, and MEK-2 [2]. Three phase I trials have been reported [3-5], and in two of these major objective responses were observed in patients with NSCLC refractory to multiple prior chemotherapy regimens. Overall, 10% of NSCLC patients treated on these trials (10 of 100 patients) experienced partial responses that were often accompanied by prompt symptomatic improvement.

The phase I data prompted two phase II monotherapy trials designed to determine the objective response rate and measure the frequency and magnitude of symptomatic benefit in patients with NSCLC previously treated with chemotherapy [6,7]. In these trials, radiographic regressions were observed in 14% of patients (61 of 426 patients; 95% CI, 11% to 18%) and symptomatic improvement in 39% of patients (165 of 426 patients; 95% CI, 34% to 43%). These results confirmed those suggested by the phase I trials of rapid and durable responses with clinically meaningful benefit for some patients. Although response rates were modest, these results compare favorably with those of cytotoxic agents commonly used in this setting [8,9].

As EGFR is present in essentially all NSCLC tumors and drug concentrations sufficient to inhibit EGFR tyrosine kinase activation are achieved in most patients, the phase II investigators sought to identify pretreatment clinical characteristics predictive of radiographic regressions. In terms of radiographic response, which in both phase II trials was a surrogate for symptomatic benefit, the most striking differences reported were noted by sex and histologic subtype of NSCLC. Responses were seen in 25% (95% CI, 18% to 32%) of women (39 of 154 patients) as compared with 8% (95% CI, 5% to 11%) of men (22 of 270 patients) and in 19% (95% CI, 15% to 24%) of patients with adenocarcinoma (53 of 274 patients) as compared with eight of 150 patients or 5% (95% CI, 2% to 9%) in other NSCLC histologies. Patients enrolled in Japan had higher radiographic response rates in the Iressa Dose Evaluation in Advanced Lung Cancer (IDEAL) 1 trial [6]. Thus to see if we could identify other pretreatment variables that predicted sensitivity to this agent, we undertook this retrospective review of Memorial Sloan-Kettering Cancer Center patients. We paid particular attention to cell type and smoking history, variables not addressed in the multicenter trials.


    PATIENTS AND METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 Authors' Disclosures of...
 REFERENCES
 
Patients
Between September 1998 and October 2002, 139 patients with NSCLC were treated with gefitinib monotherapy at our center. Eleven patients were treated on our initial phase I trial [3], six patients were treated on the IDEAL 2 study (comparing daily doses of 250 and 500 mg of gefitinib) [7], and 122 patients were treated on the Expanded Access Program, a compassionate use program that provided gefitinib preapproval for advanced NSCLC patients. All patients were cared for by a member of the Thoracic Oncology Service and had a diagnosis of NSCLC confirmed at our center. We retrospectively reviewed the records, pathology slides and reports, and imaging studies of these patients and then compared the characteristics of responders with those of the other patients. These groups of patients were analyzed for significance of stage, sex, age, Karnofsky performance status, cell type, bone metastasis, number of prior chemotherapy regimens, use of prior cisplatin or carboplatin, use of prior docetaxel, and smoking history [10].

Radiologic Evaluation
For patients with major responses, we reviewed the imaging studies performed at the initiation of gefitinib, at the time response was first assessed, and thereafter while on gefitinib using standard criteria [11]. In all cases, follow-up imaging was performed not less than 1 month after initiation of the drug, and a confirmatory imaging study was obtained 1 month or more after the initial study that documented a partial response or improvement. All imaging was reviewed by one thoracic radiologist (R.T.H.). Nonresponders were identified by physician's progress notes or review of reports of hospital radiologic studies. Resource limitations did not permit centralized review of nonresponding patients.

Pathologic Evaluation
We reviewed pathology specimens on all available patients. These were examined by a thoracic cytopathologist (M.Z.) who was unaware of patient outcome and were reported as one of the following: adenocarcinoma, adenocarcinoma with bronchioloalveolar features, bronchioloalveolar carcinoma with focal invasion, pure bronchioloalveolar cancer, squamous cell cancer, large-cell carcinoma with or without neuroendocrine features, or NSCLC not specified [12]. For purposes of analysis and based on our prior work, bronchioloalveolar cell carcinoma and its variants were considered as one entity [12].

Statistical Methods
We investigated the associations between sensitivity to gefitinib and patient characteristics. Known and potential prognostic factors explored included age, sex, Karnofsky performance status, presence of bone metastases, number of prior chemotherapy regimens, prior cisplatin, carboplatin or docetaxel use, and smoking history as reported in the patient's initial consultation note. The primary objective was to identify the factors associated with response to gefitinib. The associations between response and the covariates were assessed using Fisher's exact test or t test. Significant variables in the univariate analysis (P < .05) were then included in an exact logistic regression model with gefitinib response as the dependent variable. Those variables that were significant in the univariate analysis (P < .05) were included in a multivariable Cox regression model. Landmark survival analysis as described by Anderson et al [13] was performed at a 2-month time point when response assessment would commonly be undertaken.


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 Authors' Disclosures of...
 REFERENCES
 
One hundred thirty-nine patients with NSCLC received gefitinib on one of the three clinical trials. Ninety percent of patients received 250 mg daily; only two patients received doses less than 225 mg daily. The overall observed response rate was 15% (95% CI, 9% to 21%). Table 1 lists the patient demographics. Sixty-five percent of patients were women and 78% had adenocarcinoma. One quarter of patients had never smoked. Six (13%) of 48 males were never smokers, as opposed to 30 (33%) of 91 females (P = .009). Ten patients had tumor specimens consistent with pure bronchioloalveolar cell carcinoma, and three of these individuals had radiographic regressions. Table 2 lists results of univariate analysis of the significance of potential prognostic factors for gefitinib sensitivity using Fisher's exact test and a t test for age. None of 38 patients with a NSCLC other than an adenocarcinoma experienced a radiographic regression (0% observed rate; 95% CI, 0% to 9%; P < .001). When the adenocarcinoma group was divided into those tumors with and without elements of bronchioloalveolar cell carcinoma, the presence of bronchioloalveolar features was also found to be significant (38% v 14%; P < .001). Thirteen of 36 never smokers experienced objective regressions as compared with eight of 104 current or former smokers (36% v 8%; P < .001). The small number of current smokers precluded a separate analysis of that subgroup. Patient with Karnofsky performance status >= 80% were more likely to be sensitive to gefitinib than were those with Karnofsky performance status <= 70% (22% v 8%; P = .03). When these three factors that were significant in univariate analysis were then tested in a multivariable analysis, the presence of bronchioloalveolar features in an adenocarcinoma (or pure bronchioloalveolar cell carcinoma) and a history of never having smoked remained significant (Table 3). Figure 1 displays survival as a function of gefitinib sensitivity or resistance in a landmark analysis of all patients alive at 2 months after commencing treatment. There is a significant difference in survival between sensitive (median, 15 months; 95% CI, 12 months to not reached) and resistant patients (median, 6 months; 95% CI, 5 to 10 months; P < .001).


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Table 1. Demographics of Patients Treated With Gefitinib

 

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Table 2. Univariate Analysis of Features Associated With Sensitivity to Gefitinib

 

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Table 3. Multivariable Analysis of Features Associated With Sensitivity to Gefitinib

 


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Fig 1. Overall survival as a function of sensitivity to gefitinib.

 

    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 Authors' Disclosures of...
 REFERENCES
 
The identification of the signal transduction inhibitor gefitinib as an active agent in heavily pretreated NSCLC patients was an unprecedented observation in the treatment of this disease. The phase II trials showed that use of this drug results in partial radiographic regressions in 14% of cases and that this is associated with symptomatic improvement in 39% of such individuals.

Unlike the situation for other targeted therapies such as trastuzumab (Genentech, South San Francisco, CA) in breast cancer where a molecular screen to test for HER-2 gene amplification is standard, no such test has been established for gefitinib (or any EGFR tyrosine kinase inhibitor) in NSCLC [14]. Thus at present, this targeted therapy is given to patients with advanced NSCLC, regardless of whether EGFR signaling is a critical driver of their tumor's growth. We and others have sought to identify features that would permit us to select patients in whom this drug would be beneficial. Efforts on this front have lagged for a number of reasons, including but not limited to the following: lack of availability of adequate tissue samples to perform even the simplest immunohistochemical studies (eg, staining for the presence/absence of EGFR protein) in a majority of patients; frequent lack of readily accessible sites of tumor for rebiopsy of lesions to assess changes in putative molecular markers (eg, a decrease in phosphorylated EGFR, the basally activated form of this receptor in responding patients); the failure to standardize and validate a system for grading expression or overexpression of EGFR in tumor tissue; the complexity of the EGFR signaling pathway; and the molecular complexity of NSCLC as a result of the multiplicity of oncogenes and tumor suppressor genes affected by tobacco.

For example, in the IDEAL 2 study, performed by a number of academic institutions in the United States, pathology slides deemed adequate for performing an EGFR immunohistochemical stain were available on only 70 (32%)of 216 patients. In the recently reported Iressa NSCLC Trial Assessing Combination Treatment studies [15,16], phase III trials of cytotoxic chemotherapy with or without gefitinib, approximately 400 samples from 1,100 patients were available from each study. Although conceivably important information could emerge from these correlative studies, skepticism is raised given the challenges discussed above.

Given the lack of a ready approach to identify a molecular fingerprint associated with response, we revisited clinical data in the hopes of developing a profile of such patients. A potential advantage of our approach is the relative homogeneity of the clinical, radiographic, and pathologic assessment. All patients were treated by one of several medical oncologists, scans were reviewed by one reference radiologist, and pathology specimens were centrally reviewed by one reference cytopathologist. As a single study site, we could meticulously review the electronic medical records in a manner not feasible in a multicenter trial.

Any retrospective review raises several questions. Was our population similar to that of the prospective trials? In comparison with patients treated on IDEAL 2, two exceptions are notable. The first is that approximately 65% of our patients were women, compared with only 36% in the phase II studies. The other difference is that some of our patients had received no or one prior chemotherapy regimen, whereas two or more prior regimens were a prerequisite for entry to IDEAL 2. No study to date has suggested that the number of prior chemotherapy regimens influences likelihood of response. Both IDEAL 1 and 2 identified female sex as a baseline characteristic possibly associated with response. We believe the large proportion of women treated at our center results from both a preferential practice pattern favoring treatment of female patients with this agent and the fact that our patient population at large currently has more women than men.

A second potential cause of bias could be in the pathologic review. However, no responding patient was reclassified after a blinded review by the reference pathologist (M.Z.). Among the 118 nonresponders, 12 patients had no diagnostic material retained at our institution. Of the remaining 106 patients, 20 patients underwent reclassification. Twelve patients previously classified as having NSCLC not specified, were categorized as adenocarcinoma (10 patients), squamous cell (one patient), or large-cell neuroendocrine carcinomas (one patient). Two patients previously classified as having adenocarcinoma were considered to have bronchioloalveolar features, whereas two patients who were previously considered to have bronchioloalveolar cell carcinoma or variants thereof were classified as having pure adenocarcinomas. One patient each was recategorized from adenocarcinoma to large-cell neuroendocrine carcinoma, squamous cell to NSCLC not specified, adenocarcinoma to large-cell carcinoma, and adenocarcinoma to NSCLC not specified.

Furthermore, the smoking histories obtained may have been inconsistently defined. Never smokers are defined as individuals having a lifetime exposure of fewer than 100 cigarettes [17]. However, the social histories reported by members of our group may have been inconsistent in use of that definition, because no structured smoking questionnaire was used. Efforts to confirm documentation of never smoking status were not always possible. This, as well as the predilection of adenocarcinomas treated, might explain the disproportionately high percentage of never smokers reported herein. On the basis of our observations, future studies of EGFR tyrosine kinase inhibitors should include a validated instrument to record the smoking history. However, a recent review of subgroups of patients treated on IDEAL 2 revealed strikingly similar results to those reported here [18]. In that analysis, 29% (95% CI, 15% to 46%) of 34 nonsmokers responded to gefitinib, as opposed to 4.6% (95% CI, 2% to 11%) of 108 smokers.

With these caveats in mind, two new findings emerge from this study. First, the previously reported association of response with adenocarcinoma cell type is likely caused by those cases containing features of bronchioloalveolar carcinoma. Second, smoking status (never v current or former) emerges as a powerful and independent predictor of response. The previously described association of response and female sex was again observed but was not significant in our retrospective analysis, perhaps as a result of comigration, with smoking as a variable not previously reported in IDEAL 1 and 2.

These observations raise several questions. Why should never smokers and individuals whose tumors contain bronchioloalveolar features be more likely sensitive to gefitinib? First, lung carcinomas in smokers and never smokers may arise via distinct pathogenetic mechanisms. Genetic analysis of lung carcinomas has revealed that widespread chromosomal abnormalities are frequent in lung adenocarcinoma from smokers but infrequent in such tumors arising in never smokers [19-21]. The differences in smokers are most likely due to direct repeated exposure to tobacco-related carcinogens such as benzo[a]pyrene and N-nitrosamines, which are known to induce widespread genetic damage. For example, amplification of PI3-K{alpha}, an antiapoptotic protein downstream of EGFR, occurs in association with smoking in squamous cell carcinomas of the head and neck and is associated with cisplatin resistance in that disease [22]. Conceivably, this aberration downstream of EGFR could also explain the somewhat paradoxical resistance of squamous cell carcinomas that characteristically express more EGFR than adenocarcinomas [23]. A prospective assessment of the frequency of this amplification in newly resected snap-frozen squamous and nonsquamous cell carcinomas of the lung is ongoing.

Second, the exact molecular lesions found in never smokers may be different from those found in smokers. For example, one of the most well-characterized cigarette smoke–associated genetic mutations involves G to T transversions of the proto-oncogene K-RAS, a downstream signaling component of the EGFR activation cascade [24]. However, activating K-RAS mutations are rarely found in never smokers with primary adenocarcinomas [25]. Moreover, in a study of patients with bronchioloalveolar cell carcinomas, only two of 20 tumors were found to have K-ras mutations; both tumors were derived from patients with significant smoking histories [26]. Thus one would speculate that never smokers in our study who responded to gefitinib lack K-ras mutations. Such K-ras lesions might actually confer resistance to gefitinib by activating signaling pathways downstream of EGFR.

Because tumors in never smokers seem to be less genetically complex than their counterparts in smokers, they may be more dependent on signaling through one or only a few critical signaling pathways for tumor maintenance and survival. This could explain why gefitinib seems to induce tumor regression so rapidly in those patients that do respond, a mechanism that could be seen as analogous to inhibition by imatinib of specific activated tyrosine kinases in patients with gastrointestinal stromal tumors [27,28]. In this regard, further molecular characterization of gefitinib-responding tumors may uncover possible targets of the drug other than EGFR. Preclinically, Moasser et al [29] characterized the expression of HER family members in a broad panel of cell lines simultaneously tested for sensitivity to gefitinib and found that expression of HER-2 was the best predictor of growth inhibition, whereas EGFR expression was not correlated with the efficacy of gefitinib. Concentrations of gefitinib able to effectively inhibit the HER-2 tyrosine kinase are commonly achieved in the clinic. Intriguingly, adenocarcinomas of the lung are more likely to have 2+ or 3+ immunohistochemical staining for HER-2 than squamous cell or other NSCLC histologies [30]. More recently, Hirsch et al have looked at expression of EGFR and HER-2 in bronchioloalveolar cell carcinomas and reported that approximately one third have substantial simultaneous EGFR and HER-2 expression (F. Hirsch, personal communication, August, 2003). Thus one might hypothesize that this subset of tumors could be more effectively targeted by gefitinib than other NSCLCs.

In conclusion, sensitivity to the EGFR tyrosine kinase inhibitor gefitinib is associated with tumors with bronchioloalveolar features and with never smoking patients. Based on these observations, we plan to construct a tissue array of tumor from sensitive and resistant patients to study the EGFR pathway and genes that are frequently affected by tobacco abuse. In this way, we hope to identify for prospective testing a molecular phenotype of a patient who is likely to respond to gefitinib.


    Authors' Disclosures of Potential Conflicts of Interest
 TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 Authors' Disclosures of...
 REFERENCES
 
The following authors or their immediate family members have indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. Acted as a consultant within the last 2 years: Vincent A. Miller, AstraZeneca, Glaxo Smith Kline; Mark G. Kris, Glaxo Smith Kline, OSI Pharm; Lee M. Krug, AstraZeneca. Received more than $2,000 per year from a company for either of the last 2 years: Vincent A. Miller, AstraZeneca; Mark G. Kris, Glaxo Smith Kline, OSI Pharm; Lee M. Krug, AstraZeneca; Barbara Pizzo, AstraZeneca.


    Acknowledgment
 
We thank Samir Hattar in facilitating the central pathology review.


    NOTES
 
Supported in part by AstraZeneca, Wilmington, DE.

Presented in part at the 39th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 31-June 3, 2003, and the 10th World Conference on Lung Cancer, Vancouver, British Columbia, Canada, Aug 10-14, 2003.

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


    REFERENCES
 TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 Authors' Disclosures of...
 REFERENCES
 
1. Mendelsohn J: Blockade of receptors for growth factors: An anticancer therapy—The fourth annual Joseph H. Burchenal American Association for Cancer Research Clinical Research Award Lecture. Clin Cancer Res 6:747-753, 2000[Free Full Text]

2. Wakeling AE, Guy SP, Woodburn JR, et al: ZD1839 (Iressa): An orally active inhibitor of epidermal growth factor signaling with potential for cancer therapy. Cancer Res 62:5749-5754, 2002[Abstract/Free Full Text]

3. Ranson M, Hammond LA, Ferry D, et al: ZD1839, a selective oral epidermal growth factor receptor-tyrosine kinase inhibitor, is well tolerated and active in patients with solid, malignant tumors: Results of a phase I trial. J Clin Oncol 20:2240-2250, 2002[Abstract/Free Full Text]

4. Baselga J, Rischin D, Ranson M, et al: Phase I safety, pharmacokinetic, and pharmacodynamic trial of ZD1839, a selective oral epidermal growth factor receptor tyrosine kinase inhibitor, in patients with five selected solid tumor types. J Clin Oncol 20:4292-4302, 2002[Abstract/Free Full Text]

5. Herbst RS, Maddox A-M, Rothenberg ML, et al: Selective oral epidermal growth factor receptor tyrosine kinase inhibitor ZD1839 is generally well-tolerated and has activity in non–small-cell lung cancer and other solid tumors: Results of a phase I trial. J Clin Oncol 20:3815-3825, 2002[Abstract/Free Full Text]

6. Fukuoka M, Yano S, Giaccone G, et al: Multi-institutional randomized phase II trial of gefitinib for previously treated patients with advanced non–small-cell lung cancer. J Clin Oncol 21:2237-2246, 2003[Abstract/Free Full Text]

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19. Sanchez-Cespedes M, Ahrendt SA, Piantadosi S, et al: Chromosomal alterations in lung adenocarcinoma from smokers and nonsmokers. Cancer Res 61:1309-1313, 2001[Abstract/Free Full Text]

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22. Singh B, Reddy PG, Goberdhan A, et al: p53 regulates cell survival by inhibiting PIK3CA in squamous cell carcinomas. Genes Dev 16:984-993, 2002[Abstract/Free Full Text]

23. Rusch V, Klimstra D, Venkatraman E, et al: Overexpression of the epidermal growth factor receptor and its ligand transforming growth factor alpha is frequent in resectable non-small cell lung cancer but does not predict tumor progression. Clin Cancer Res 3:515-522, 1997[Abstract]

24. Arteaga CL: The epidermal growth factor receptor: From mutant oncogene in nonhuman cancers to therapeutic target in human neoplasia. J Clin Oncol 19:32S-40S, 2001 (suppl)

25. Ahrendt SA, Decker PA, Alawi EA, et al: Cigarette smoking is strongly associated with mutation of the K-ras gene in patients with primary adenocarcinoma of the lung. Cancer 92:1525-1530, 2001[CrossRef][Medline]

26. Rusch VW, Reuter VE, Kris MG, et al: Ras oncogene point mutation: An infrequent event in bronchioloalveolar cancer. J Thorac Cardiovasc Surg 104:1465-1469, 1992[Abstract]

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29. Moasser M, Basso A, Averbuch S, et al: The tyrosine kinase inhibitor ZD1839 ("Iressa") inhibits HER2-driven signaling and suppresses the growth of HER2-overexpressing tumor cells. Cancer Res 61:7184-7188, 2001[Abstract/Free Full Text]

30. Krug LM, Miller VA, Crapanzano J, et al: Randomized phase II trial of trastuzumab (tras) plus either weekly docetaxel (doc) or paclitaxel (pac) in previously untreated advanced non-small cell lung cancer (NSCLC). Proc Am Soc Clin Oncol 20:333a, 2001 (abstr 1328)

Submitted August 22, 2003; accepted January 7, 2004.


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Micropapillary Histology: A Frequent Morphology of Mutation-Associated Lung Adenocarcinoma?
Am J Clin Pathol, May 1, 2009; 131(5): 615 - 617.
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Am J Clin PatholHome page
R. De Oliveira Duarte Achcar, M. N. Nikiforova, and S. A. Yousem
Micropapillary Lung Adenocarcinoma: EGFR, K-ras, and BRAF Mutational Profile
Am J Clin Pathol, May 1, 2009; 131(5): 694 - 700.
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Am J Clin PatholHome page
G. Sartori, A. Cavazza, A. Sgambato, A. Marchioni, F. Barbieri, L. Longo, M. Bavieri, B. Murer, E. Meschiari, S. Tamberi, et al.
EGFR and K-ras Mutations Along the Spectrum of Pulmonary Epithelial Tumors of the Lung and Elaboration of a Combined Clinicopathologic and Molecular Scoring System to Predict Clinical Responsiveness to EGFR Inhibitors
Am J Clin Pathol, April 1, 2009; 131(4): 478 - 489.
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JCOHome page
F. Cappuzzo, A. Marchetti, M. Skokan, E. Rossi, S. Gajapathy, L. Felicioni, M. del Grammastro, M. G. Sciarrotta, F. Buttitta, M. Incarbone, et al.
Increased MET Gene Copy Number Negatively Affects Survival of Surgically Resected Non-Small-Cell Lung Cancer Patients
J. Clin. Oncol., April 1, 2009; 27(10): 1667 - 1674.
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JCOHome page
G. J. Riely, N. A. Rizvi, M. G. Kris, D. T. Milton, D. B. Solit, N. Rosen, E. Senturk, C. G. Azzoli, J. R. Brahmer, F. M. Sirotnak, et al.
Randomized Phase II Study of Pulse Erlotinib Before or After Carboplatin and Paclitaxel in Current or Former Smokers With Advanced Non-Small-Cell Lung Cancer
J. Clin. Oncol., January 10, 2009; 27(2): 264 - 270.
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Mol. Pharmacol.Home page
L. Marek, K. E. Ware, A. Fritzsche, P. Hercule, W. R. Helton, J. E. Smith, L. A. McDermott, C. D. Coldren, R. A. Nemenoff, D. T. Merrick, et al.
Fibroblast Growth Factor (FGF) and FGF Receptor-Mediated Autocrine Signaling in Non-Small-Cell Lung Cancer Cells
Mol. Pharmacol., January 1, 2009; 75(1): 196 - 207.
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Cancer Res.Home page
S. Yano, W. Wang, Q. Li, K. Matsumoto, H. Sakurama, T. Nakamura, H. Ogino, S. Kakiuchi, M. Hanibuchi, Y. Nishioka, et al.
Hepatocyte Growth Factor Induces Gefitinib Resistance of Lung Adenocarcinoma with Epidermal Growth Factor Receptor-Activating Mutations
Cancer Res., November 15, 2008; 68(22): 9479 - 9487.
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Clin. Cancer Res.Home page
H.-J. Sohn, Y.-J. Yang, J.-S. Ryu, S. J. Oh, K. C. Im, D. H. Moon, D. H. Lee, C. Suh, J.-S. Lee, and S.-W. Kim
[18F]Fluorothymidine Positron Emission Tomography before and 7 Days after Gefitinib Treatment Predicts Response in Patients with Advanced Adenocarcinoma of the Lung
Clin. Cancer Res., November 15, 2008; 14(22): 7423 - 7429.
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The OncologistHome page
R. S. Herbst and A. Sandler
Bevacizumab and Erlotinib: A Promising New Approach to the Treatment of Advanced NSCLC
Oncologist, November 1, 2008; 13(11): 1166 - 1176.
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The OncologistHome page
T. E. Stinchcombe and M. A. Socinski
Gefitinib in Advanced Non-Small Cell Lung Cancer: Does It Deserve a Second Chance?
Oncologist, September 1, 2008; 13(9): 933 - 944.
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Proc. Natl. Acad. Sci. USAHome page
S. Aviel-Ronen, B. P. Coe, S. K. Lau, G. da Cunha Santos, C.-Q. Zhu, D. Strumpf, I. Jurisica, W. L. Lam, and M.-S. Tsao
Genomic markers for malignant progression in pulmonary adenocarcinoma with bronchioloalveolar features
PNAS, July 22, 2008; 105(29): 10155 - 10160.
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Ann OncolHome page
G. J. Weiss, L. T. Bemis, E. Nakajima, M. Sugita, D. K. Birks, W. A. Robinson, M. Varella-Garcia, P. A. Bunn Jr, J. Haney, B. A. Helfrich, et al.
EGFR regulation by microRNA in lung cancer: correlation with clinical response and survival to gefitinib and EGFR expression in cell lines
Ann. Onc., June 1, 2008; 19(6): 1053 - 1059.
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JCOHome page
V. L. Keedy, C. L. Arteaga, and D. H. Johnson
Does Gefitinib Shorten Lung Cancer Survival? Chaos Redux
J. Clin. Oncol., May 20, 2008; 26(15): 2428 - 2430.
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JCOHome page
V. A. Miller, G. J. Riely, M. F. Zakowski, A. R. Li, J. D. Patel, R. T. Heelan, M. G. Kris, A. B. Sandler, D. P. Carbone, A. Tsao, et al.
Molecular Characteristics of Bronchioloalveolar Carcinoma and Adenocarcinoma, Bronchioloalveolar Carcinoma Subtype, Predict Response to Erlotinib
J. Clin. Oncol., March 20, 2008; 26(9): 1472 - 1478.
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NEJMHome page
F. Ciardiello and G. Tortora
EGFR Antagonists in Cancer Treatment
N. Engl. J. Med., March 13, 2008; 358(11): 1160 - 1174.
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JCOHome page
D. A. Eberhard, G. Giaccone, and B. E. Johnson
Biomarkers of Response to Epidermal Growth Factor Receptor Inhibitors in Non-Small-Cell Lung Cancer Working Group: Standardization for Use in the Clinical Trial Setting
J. Clin. Oncol., February 20, 2008; 26(6): 983 - 994.
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Ann. Thorac. Surg.Home page
I. S. Sarkaria, M. F. Zakowski, D. Pham, M. Hezel, M. I. Ebright, S. Chuai, E. S. Venkatraman, M. G. Kris, V. W. Rusch, and B. Singh
Epidermal Growth Factor Receptor Signaling in Adenocarcinomas With Bronchioloalveolar Components
Ann. Thorac. Surg., January 1, 2008; 85(1): 216 - 223.
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JCOHome page
P. A. Janne, J. von Pawel, R. B. Cohen, L. Crino, C. A. Butts, S. S. Olson, I. A. Eiseman, A. A. Chiappori, B. Y. Yeap, P. F. Lenehan, et al.
Multicenter, Randomized, Phase II Trial of CI-1033, an Irreversible Pan-ERBB Inhibitor, for Previously Treated Advanced Non Small-Cell Lung Cancer
J. Clin. Oncol., September 1, 2007; 25(25): 3936 - 3944.
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Clin. Cancer Res.Home page
G. J. Riely, M. G. Kris, B. Zhao, T. Akhurst, D. T. Milton, E. Moore, L. Tyson, W. Pao, N. A. Rizvi, L. H. Schwartz, et al.
Prospective Assessment of Discontinuation and Reinitiation of Erlotinib or Gefitinib in Patients with Acquired Resistance to Erlotinib or Gefitinib Followed by the Addition of Everolimus
Clin. Cancer Res., September 1, 2007; 13(17): 5150 - 5155.
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ChestHome page
D. Arenberg
Bronchioloalveolar Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition)
Chest, September 1, 2007; 132(3_suppl): 306S - 313S.
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JCOHome page
K. J. O'Byrne, S. Danson, D. Dunlop, N. Botwood, F. Taguchi, D. Carbone, and M. Ranson
Combination Therapy With Gefitinib and Rofecoxib in Patients With Platinum-Pretreated Relapsed Non Small-Cell Lung Cancer
J. Clin. Oncol., August 1, 2007; 25(22): 3266 - 3273.
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Clin. Cancer Res.Home page
K.-K. Wong
HKI-272 in Non Small Cell Lung Cancer
Clin. Cancer Res., August 1, 2007; 13(15): 4593s - 4596s.
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Clin. Cancer Res.Home page
P. D. Bonomi, L. Buckingham, and J. Coon
Selecting Patients for Treatment with Epidermal Growth Factor Tyrosine Kinase Inhibitors
Clin. Cancer Res., August 1, 2007; 13(15): 4606s - 4612s.
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The OncologistHome page
C. Gridelli, M. A. Bareschino, C. Schettino, A. Rossi, P. Maione, and F. Ciardiello
Erlotinib in Non-Small Cell Lung Cancer Treatment: Current Status and Future Development
Oncologist, July 1, 2007; 12(7): 840 - 849.
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JCOHome page
F. Cappuzzo, C. Ligorio, P. A. Janne, L. Toschi, E. Rossi, R. Trisolini, D. Paioli, A. J. Holmes, E. Magrini, G. Finocchiaro, et al.
Prospective Study of Gefitinib in Epidermal Growth Factor Receptor Fluorescence In Situ Hybridization-Positive/Phospho-Akt-Positive or Never Smoker Patients With Advanced Non-Small-Cell Lung Cancer: The ONCOBELL Trial
J. Clin. Oncol., June 1, 2007; 25(16): 2248 - 2255.
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Ann OncolHome page
F. Hirsch, M Varella-Garcia, F Cappuzzo, J McCoy, L Bemis, A. Xavier, R Dziadziuszko, P Gumerlock, K Chansky, H West, et al.
Combination of EGFR gene copy number and protein expression predicts outcome for advanced non-small-cell lung cancer patients treated with gefitinib
Ann. Onc., April 1, 2007; 18(4): 752 - 760.
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Molecular Cancer TherapeuticsHome page
L. Daniele, L. Macri, M. Schena, D. Dongiovanni, L. Bonello, E. Armando, L. Ciuffreda, O. Bertetto, G. Bussolati, and A. Sapino
Predicting gefitinib responsiveness in lung cancer by fluorescence in situ hybridization/chromogenic in situ hybridization analysis of EGFR and HER2 in biopsy and cytology specimens
Mol. Cancer Ther., April 1, 2007; 6(4): 1223 - 1229.
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Ann OncolHome page
N van Zandwijk and M. van de Vijver
clairvoyance or reliable prediction of the future?
Ann. Onc., March 1, 2007; 18(3): 407 - 408.
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The OncologistHome page
L. V. Sequist
Second-Generation Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Non-Small Cell Lung Cancer
Oncologist, March 1, 2007; 12(3): 325 - 330.
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JCOHome page
J. Subramanian and R. Govindan
Lung Cancer in Never Smokers: A Review
J. Clin. Oncol., February 10, 2007; 25(5): 561 - 570.
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Clin. Cancer Res.Home page
T. Okano, T. Kondo, K. Fujii, T. Nishimura, T. Takano, Y. Ohe, K. Tsuta, Y. Matsuno, A. Gemma, H. Kato, et al.
Proteomic Signature Corresponding to the Response to Gefitinib (Iressa, ZD1839), an Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor in Lung Adenocarcinoma
Clin. Cancer Res., February 1, 2007; 13(3): 799 - 805.
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Eur Respir JHome page
R. van Puijenbroek, L. Bosquee, A-P. Meert, D. Schallier, J-C. Goeminne, G. Tits, P. Collard, K. Nackaerts, J-L. Canon, F. Duplaquet, et al.
Gefitinib monotherapy in advanced nonsmall cell lung cancer: a large Western community implementation study
Eur. Respir. J., January 1, 2007; 29(1): 128 - 133.
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Ann OncolHome page
N van Zandwijk, A Mathy, L Boerrigter, H Ruijter, I Tielen, D de Jong, P Baas, S Burgers, and P Nederlof
EGFR and KRAS mutations as criteria for treatment with tyrosine kinase inhibitors: retro- and prospective observations in non-small-cell lung cancer
Ann. Onc., January 1, 2007; 18(1): 99 - 103.
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The OncologistHome page
L. V. Sequist, V. A. Joshi, P. A. Janne, A. Muzikansky, P. Fidias, M. Meyerson, D. A. Haber, R. Kucherlapati, B. E. Johnson, and T. J. Lynch
Response to treatment and survival of patients with non-small cell lung cancer undergoing somatic EGFR mutation testing.
Oncologist, January 1, 2007; 12(1): 90 - 98.
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Clin. Cancer Res.Home page
G. J. Riely, K. A. Politi, V. A. Miller, and W. Pao
Update on Epidermal Growth Factor Receptor Mutations in Non-Small Cell Lung Cancer
Clin. Cancer Res., December 15, 2006; 12(24): 7232 - 7241.
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Cancer Res.Home page
S. Kobayashi, T. Shimamura, S. Monti, U. Steidl, C. J. Hetherington, A. M. Lowell, T. Golub, M. Meyerson, D. G. Tenen, G. I. Shapiro, et al.
Transcriptional Profiling Identifies Cyclin D1 as a Critical Downstream Effector of Mutant Epidermal Growth Factor Receptor Signaling
Cancer Res., December 1, 2006; 66(23): 11389 - 11398.
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Clin. Cancer Res.Home page
B. A. Helfrich, D. Raben, M. Varella-Garcia, D. Gustafson, D. C. Chan, L. Bemis, C. Coldren, A. Baron, C. Zeng, W. A. Franklin, et al.
Antitumor Activity of the Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitor Gefitinib (ZD1839, Iressa) in Non-Small Cell Lung Cancer Cell Lines Correlates with Gene Copy Number and EGFR Mutations but not EGFR Protein Levels
Clin. Cancer Res., December 1, 2006; 12(23): 7117 - 7125.
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J. Thorac. Cardiovasc. Surg.Home page
D. J. Raz, A. Y. Odisho, B. L. Franc, and D. M. Jablons
Tumor fluoro-2-deoxy-D-glucose avidity on positron emission tomographic scan predicts mortality in patients with early-stage pure and mixed bronchioloalveolar carcinoma.
J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1189 - 1195.
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Jpn J Clin OncolHome page
W.-C. Chou, S.-F. Huang, K.-Y. Yeh, H.-M. Wang, M.-Y. Liu, J.-J. Hsieh, Y.-C. Cheung, and J. W.-C. Chang
Different Responses to Gefitinib in Lung Adenocarcinoma Coexpressing Mutant- and Wild-Type Epidermal Growth Factor Receptor Genes
Jpn. J. Clin. Oncol., August 1, 2006; 36(8): 523 - 526.
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Mol Cancer ResHome page
C. D. Coldren, B. A. Helfrich, S. E. Witta, M. Sugita, R. Lapadat, C. Zeng, A. Baron, W. A. Franklin, F. R. Hirsch, M. W. Geraci, et al.
Baseline Gene Expression Predicts Sensitivity to Gefitinib in Non-Small Cell Lung Cancer Cell Lines
Mol. Cancer Res., August 1, 2006; 4(8): 521 - 528.
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JCOHome page
A. Inoue, T. Suzuki, T. Fukuhara, M. Maemondo, Y. Kimura, N. Morikawa, H. Watanabe, Y. Saijo, and T. Nukiwa
Prospective Phase II Study of Gefitinib for Chemotherapy-Naive Patients With Advanced Non-Small-Cell Lung Cancer With Epidermal Growth Factor Receptor Gene Mutations
J. Clin. Oncol., July 20, 2006; 24(21): 3340 - 3346.
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Clin. Cancer Res.Home page
R. K. Thomas, B. Weir, and M. Meyerson
Genomic approaches to lung cancer.
Clin. Cancer Res., July 15, 2006; 12(14): 4384s - 4391s.
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Clin. Cancer Res.Home page
L. V. Sequist, V. A. Joshi, P. A. Janne, D. W. Bell, P. Fidias, N. I. Lindeman, D. N. Louis, J. C. Lee, E. J. Mark, J. Longtine, et al.
Epidermal growth factor receptor mutation testing in the care of lung cancer patients.
Clin. Cancer Res., July 15, 2006; 12(14): 4403s - 4408s.
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Clin. Cancer Res.Home page
P. A. Janne and B. E. Johnson
Effect of epidermal growth factor receptor tyrosine kinase domain mutations on the outcome of patients with non-small cell lung cancer treated with epidermal growth factor receptor tyrosine kinase inhibitors.
Clin. Cancer Res., July 15, 2006; 12(14): 4416s - 4420s.
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Clin. Cancer Res.Home page
J. Dimitroulakos, I. A. Lorimer, and G. Goss
Strategies to enhance epidermal growth factor inhibition: targeting the mevalonate pathway.
Clin. Cancer Res., July 15, 2006; 12(14): 4426s - 4431s.
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Clin. Cancer Res.Home page
P. A. Bunn Jr., R. Dziadziuszko, M. Varella-Garcia, W. A. Franklin, S. E. Witta, K. Kelly, and F. R. Hirsch
Biological Markers for Non-Small Cell Lung Cancer Patient Selection for Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Therapy.
Clin. Cancer Res., June 15, 2006; 12(12): 3652 - 3656.
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Clin. Cancer Res.Home page
D. J. Raz, B. He, R. Rosell, and D. M. Jablons
Current concepts in bronchioloalveolar carcinoma biology.
Clin. Cancer Res., June 15, 2006; 12(12): 3698 - 3704.
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JCOHome page
M. Ando, I. Okamoto, N. Yamamoto, K. Takeda, K. Tamura, T. Seto, Y. Ariyoshi, and M. Fukuoka
Predictive Factors for Interstitial Lung Disease, Antitumor Response, and Survival in Non-Small-Cell Lung Cancer Patients Treated With Gefitinib
J. Clin. Oncol., June 1, 2006; 24(16): 2549 - 2556.
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Eur Respir JHome page
F. Suau, V. Cottin, F. Archer, S. Croze, J. Chastang, G. Cordier, F. Thivolet-Bejui, J-F. Mornex, and C. Leroux
Telomerase activation in a model of lung adenocarcinoma
Eur. Respir. J., June 1, 2006; 27(6): 1175 - 1182.
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Clin. Cancer Res.Home page
E. E. Vokes, M. C. Perry, H. L. Kindler, and M. R. Green
The cancer and leukemia group B respiratory committee.
Clin. Cancer Res., June 1, 2006; 12(11): 3581s - 3588s.
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The OncologistHome page
S. Ramalingam and A. B. Sandler
Salvage therapy for advanced non-small cell lung cancer: factors influencing treatment selection.
Oncologist, June 1, 2006; 11(6): 655 - 665.
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Genes Dev.Home page
K. Politi, M. F. Zakowski, P.-D. Fan, E. A. Schonfeld, W. Pao, and H. E. Varmus
Lung adenocarcinomas induced in mice by mutant EGF receptors found in human lung cancers respond to a tyrosine kinase inhibitor or to down-regulation of the receptors
Genes & Dev., June 1, 2006; 20(11): 1496 - 1510.
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JCOHome page
E. Calvo and J. Baselga
Ethnic Differences in Response to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors
J. Clin. Oncol., May 10, 2006; 24(14): 2158 - 2163.
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JCOHome page
H. L. West, W. A. Franklin, J. McCoy, P. H. Gumerlock, R. Vance, D. H.M. Lau, K. Chansky, J. J. Crowley, and D. R. Gandara
Gefitinib Therapy in Advanced Bronchioloalveolar Carcinoma: Southwest Oncology Group Study S0126
J. Clin. Oncol., April 20, 2006; 24(12): 1807 - 1813.
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Jpn J Clin OncolHome page
H. Haneda, H. Sasaki, N. Lindeman, O. Kawano, K. Endo, E. Suzuki, S. Shimizu, H. Yukiue, Y. Kobayashi, M. Yano, et al.
A Correlation between EGFR Gene Mutation Status and Bronchioloalveolar Carcinoma Features in Japanese Patients with Adenocarcinoma
Jpn. J. Clin. Oncol., February 1, 2006; 36(2): 69 - 75.
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Clin. Cancer Res.Home page
G. J. Riely, W. Pao, D. Pham, A. R. Li, N. Rizvi, E. S. Venkatraman, M. F. Zakowski, M. G. Kris, M. Ladanyi, and V. A. Miller
Clinical Course of Patients with Non-Small Cell Lung Cancer and Epidermal Growth Factor Receptor Exon 19 and Exon 21 Mutations Treated with Gefitinib or Erlotinib
Clin. Cancer Res., February 1, 2006; 12(3): 839 - 844.
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The Annals of PharmacotherapyHome page
M. H Nelson and C. R Dolder
Lapatinib: A Novel Dual Tyrosine Kinase Inhibitor with Activity in Solid Tumors
Ann. Pharmacother., February 1, 2006; 40(2): 261 - 269.
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JCOHome page
G. Rossi, A. Cavazza, A. Marchioni, L. Longo, M. Migaldi, G. Sartori, N. Bigiani, L. Schirosi, C. Casali, U. Morandi, et al.
Role of Chemotherapy and the Receptor Tyrosine Kinases KIT, PDGFR{alpha}, PDGFR{beta}, and Met in Large-Cell Neuroendocrine Carcinoma of the Lung
J. Clin. Oncol., December 1, 2005; 23(34): 8774 - 8785.
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Ann OncolHome page
T. Dutu, S. Michiels, P. Fouret, F. Penault-Llorca, P. Validire, S. Benhamou, E. Taranchon, L. Morat, D. Grunenwald, T. Le Chevalier, et al.
Differential expression of biomarkers in lung adenocarcinoma: a comparative study between smokers and never-smokers
Ann. Onc., December 1, 2005; 16(12): 1906 - 1914.
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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.
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JCOHome page
J. A. Zell, S.-H. I. Ou, A. Ziogas, and H. Anton-Culver
Epidemiology of Bronchioloalveolar Carcinoma: Improvement in Survival After Release of the 1999 WHO Classification of Lung Tumors
J. Clin. Oncol., November 20, 2005; 23(33): 8396 - 8405.
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JCOHome page
C. Ho, J. Davis, F. Anderson, G. Bebb, and N. Murray
Side Effects Related to Cancer Treatment: CASE 1. Hepatitis Following Treatment With Gefitinib
J. Clin. Oncol., November 20, 2005; 23(33): 8531 - 8533.
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NEJMHome page
I. K. Mellinghoff, M. Y. Wang, I. Vivanco, D. A. Haas-Kogan, S. Zhu, E. Q. Dia, K. V. Lu, K. Yoshimoto, J. H.Y. Huang, D. J. Chute, et al.
Molecular Determinants of the Response of Glioblastomas to EGFR Kinase Inhibitors.
N. Engl. J. Med., November 10, 2005; 353(19): 2012 - 2024.
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Cancer Res.Home page
N. Ishikawa, Y. Daigo, A. Takano, M. Taniwaki, T. Kato, S. Hayama, H. Murakami, Y. Takeshima, K. Inai, H. Nishimura, et al.
Increases of Amphiregulin and Transforming Growth Factor-{alpha} in Serum as Predictors of Poor Response to Gefitinib among Patients with Advanced Non-Small Cell Lung Cancers
Cancer Res., October 15, 2005; 65(20): 9176 - 9184.
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JCOHome page
F. R. Hirsch, M. Varella-Garcia, J. McCoy, H. West, A. C. Xavier, P. Gumerlock, P. A. Bunn Jr, W. A. Franklin, J. Crowley, and D. R. Gandara
Increased Epidermal Growth Factor Receptor Gene Copy Number Detected by Fluorescence In Situ Hybridization Associates With Increased Sensitivity to Gefitinib in Patients With Bronchioloalveolar Carcinoma Subtypes: A Southwest Oncology Group Study
J. Clin. Oncol., October 1, 2005; 23(28): 6838 - 6845.
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T. Takano, Y. Ohe, H. Sakamoto, K. Tsuta, Y. Matsuno, U. Tateishi, S. Yamamoto, H. Nokihara, N. Yamamoto, I. Sekine, et al.
Epidermal Growth Factor Receptor Gene Mutations and Increased Copy Numbers Predict Gefitinib Sensitivity in Patients With Recurrent Non-Small-Cell Lung Cancer
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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.
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The OncologistHome page
W. P. Tew, D. P. Kelsen, and D. H. Ilson
Targeted Therapies for Esophageal Cancer
Oncologist, September 1, 2005; 10(8): 590 - 601.
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L. V. Sequist, D. A. Haber, and T. J. Lynch
Epidermal Growth Factor Receptor Mutations in Non-Small Cell Lung Cancer: Predicting Clinical Response to Kinase Inhibitors
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F. Cappuzzo, M. Varella-Garcia, H. Shigematsu, I. Domenichini, S. Bartolini, G. L. Ceresoli, E. Rossi, V. Ludovini, V. Gregorc, L. Toschi, et al.
Increased HER2 Gene Copy Number Is Associated With Response to Gefitinib Therapy in Epidermal Growth Factor Receptor-Positive Non-Small-Cell Lung Cancer Patients
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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
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NEJMHome page
F. A. Shepherd, J. Rodrigues Pereira, T. Ciuleanu, E. H. Tan, V. Hirsh, S. Thongprasert, D. Campos, S. Maoleekoonpiroj, M. Smylie, R. Martins, et al.
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M. S. Tsao, A. Sakurada, J.-C. Cutz, C.-Q. Zhu, S. Kamel-Reid, J. Squire, I. Lorimer, T. Zhang, N. Liu, M. Daneshmand, et al.
Erlotinib in Lung Cancer -- Molecular and Clinical Predictors of Outcome
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ChestHome page
Z. Zheng, G. Bepler, A. Cantor, and E. B. Haura
Small Tumor Size and Limited Smoking History Predicts Activated Epidermal Growth Factor Receptor in Early-Stage Non-small Cell Lung Cancer
Chest, July 1, 2005; 128(1): 308 - 316.
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ChestHome page
R.-K. Hsieh, K.-H. Lim, H.-T. Kuo, C.-Y. Tzen, and M.-J. Huang
Female Sex and Bronchioloalveolar Pathologic Subtype Predict EGFR Mutations in Non-small Cell Lung Cancer
Chest, July 1, 2005; 128(1): 317 - 321.
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Clin. Cancer Res.Home page
X. L. Mu, L. Y. Li, X. T. Zhang, M. Z. Wang, R. E. Feng, Q. C. Cui, H. S. Zhou, and B. Q. Guo
Gefitinib-Sensitive Mutations of the Epidermal Growth Factor Receptor Tyrosine Kinase Domain in Chinese Patients with Non-Small Cell Lung Cancer
Clin. Cancer Res., June 15, 2005; 11(12): 4289 - 4294.
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ChestHome page
O. Altundag, K. Altundag, P. Morandi, and M. Gunduz
Association Between Epidermal Growth Factor Receptor Mutation and Improved Survival in Never-Smokers With Primary Adenocarcinoma of the Lung
Chest, June 1, 2005; 127(6): 2292 - 2292.
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Clin. Cancer Res.Home page
T.-Y. Chou, C.-H. Chiu, L.-H. Li, C.-Y. Hsiao, C.-Y. Tzen, K.-T. Chang, Y.-M. Chen, R.-P. Perng, S.-F. Tsai, and C.-M. Tsai
Mutation in the Tyrosine Kinase Domain of Epidermal Growth Factor Receptor Is a Predictive and Prognostic Factor for Gefitinib Treatment in Patients with Non-Small Cell Lung Cancer
Clin. Cancer Res., May 15, 2005; 11(10): 3750 - 3757.
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JCOHome page
P. A. Janne, J. A. Engelman, and B. E. Johnson
Epidermal Growth Factor Receptor Mutations in Non-Small-Cell Lung Cancer: Implications for Treatment and Tumor Biology
J. Clin. Oncol., May 10, 2005; 23(14): 3227 - 3234.
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JCOHome page
G. Giaccone
Epidermal Growth Factor Receptor Inhibitors in the Treatment of Non-Small-Cell Lung Cancer
J. Clin. Oncol., May 10, 2005; 23(14): 3235 - 3242.
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JCOHome page
K. M.W. Pisters and T. Le Chevalier
Adjuvant Chemotherapy in Completely Resected Non-Small-Cell Lung Cancer
J. Clin. Oncol., May 10, 2005; 23(14): 3270 - 3278.
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JCOHome page
W. D. Travis, K. Garg, W. A. Franklin, I. I. Wistuba, B. Sabloff, M. Noguchi, R. Kakinuma, M. Zakowski, M. Ginsberg, R. Padera, et al.
Evolving Concepts in the Pathology and Computed Tomography Imaging of Lung Adenocarcinoma and Bronchioloalveolar Carcinoma
J. Clin. Oncol., May 10, 2005; 23(14): 3279 - 3287.
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JCOHome page
V. A. Miller, F. R. Hirsch, and D. H. Johnson
Systemic Therapy of Advanced Bronchioloalveolar Cell Carcinoma: Challenges and Opportunities
J. Clin. Oncol., May 10, 2005; 23(14): 3288 - 3293.
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JNCI J Natl Cancer InstHome page
F. Cappuzzo, F. R. Hirsch, E. Rossi, S. Bartolini, G. L. Ceresoli, L. Bemis, J. Haney, S. Witta, K. Danenberg, I. Domenichini, et al.
Epidermal Growth Factor Receptor Gene and Protein and Gefitinib Sensitivity in Non-Small-Cell Lung Cancer
J Natl Cancer Inst, May 4, 2005; 97(9): 643 - 655.
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Ann OncolHome page
M. K. Mohamed, S. Ramalingam, Y. Lin, W. Gooding, and C. P. Belani
Skin rash and good performance status predict improved survival with gefitinib in patients with advanced non-small cell lung cancer
Ann. Onc., May 1, 2005; 16(5): 780 - 785.
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Clin. Cancer Res.Home page
H. Sasaki, K. Endo, A. Konishi, M. Takada, M. Kawahara, K. Iuchi, A. Matsumura, M. Okumura, H. Tanaka, T. Kawaguchi, et al.
EGFR Mutation Status in Japanese Lung Cancer Patients: Genotyping Analysis Using LightCycler
Clin. Cancer Res., April 15, 2005; 11(8): 2924 - 2929.
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Clin. Cancer Res.Home page
D. H. Lee, J.-Y. Han, H. G. Lee, J. J. Lee, E. K. Lee, H. Y. Kim, H. K. Kim, E. K. Hong, and J. S. Lee
Gefitinib as a First-Line Therapy of Advanced or Metastatic Adenocarcinoma of the Lung in Never-Smokers
Clin. Cancer Res., April 15, 2005; 11(8): 3032 - 3037.
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S.-W. Han, T.-Y. Kim, P. G. Hwang, S. Jeong, J. Kim, I. S. Choi, D.-Y. Oh, J. H. Kim, D.-W. Kim, D. H. Chung, et al.
Predictive and Prognostic Impact of Epidermal Growth Factor Receptor Mutation in Non-Small-Cell Lung Cancer Patients Treated With Gefitinib
J. Clin. Oncol., April 10, 2005; 23(11): 2493 - 2501.
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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.
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JCOHome page
W. Pao and V. A. Miller
Epidermal Growth Factor Receptor Mutations, Small-Molecule Kinase Inhibitors, and Non-Small-Cell Lung Cancer: Current Knowledge and Future Directions
J. Clin. Oncol., April 10, 2005; 23(11): 2556 - 2568.
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Ann OncolHome page
G. Giaccone
HER1/EGFR-targeted agents: predicting the future for patients with unpredictable outcomes to therapy
Ann. Onc., April 1, 2005; 16(4): 538 - 548.
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Clin. Cancer Res.Home page
K.-S. Kim, J.-Y. Jeong, Y.-C. Kim, K.-J. Na, Y.-H. Kim, S.-J. Ahn, S.-M. Baek, C.-S. Park, C.-M. Park, Y.-I. Kim, et al.
Predictors of the Response to Gefitinib in Refractory Non-Small Cell Lung Cancer
Clin. Cancer Res., March 15, 2005; 11(6): 2244 - 2251.
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Clin. Cancer Res.Home page
A. J. Mantha, J. E.L. Hanson, G. Goss, A. E. Lagarde, I. A. Lorimer, and J. Dimitroulakos
Targeting the Mevalonate Pathway Inhibits the Function of the Epidermal Growth Factor Receptor
Clin. Cancer Res., March 15, 2005; 11(6): 2398 - 2407.
[Abstract] [Full Text] [PDF]


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