Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
Search Ahead of print Current Issue Archives Instructions Subscribe e-Alerts Login 
Home Email this article link Print this article Bookmark this page Decrease font size Default font size Increase font size

Table of Contents   
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 173-178
Prevalence of the epidermal growth factor receptor mutations in lung adenocarcinoma patients from the Middle East region

Department of Internal Medicine, Division of Hematology and Oncology, American University of Beirut, Beirut, Lebanon

Date of Submission29-Nov-2018
Date of Acceptance02-Feb-2019
Date of Web Publication26-Jun-2019

Correspondence Address:
Dr. Arafat Hussein Tfayli
American University of Beirut Medical Center, Naef K. Basile Cancer Institute, 11-0236, Riad El Solh, 1107 2020, Beirut
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/atm.ATM_344_18

Rights and Permissions


Lung cancer remains a major cause of cancer mortality with a 5-year survival in advanced stages around 4%. Platinum-based chemotherapy was routinely used as the standard of care in patients with advanced nonsmall cell lung cancer, but it is being progressively replaced by targeted molecular therapy. One of the molecular aberrations harbored by lung adenocarcinoma is the epidermal growth factor receptor (EGFR). A large ethnic variation has been reported in the prevalence of EGFR mutations in patients with lung adenocarcinoma. Data regarding its prevalence from the Middle East area remains limited. This paper aims at reviewing the data available for the prevalence of this mutation in the Middle Eastern patient population and comparing it with other reported series.

Keywords: Epidermal growth factor receptor, lung adenocarcinoma, middle east, prevalence

How to cite this article:
Tfayli AH, Fakhri GB, Al Assaad MS. Prevalence of the epidermal growth factor receptor mutations in lung adenocarcinoma patients from the Middle East region. Ann Thorac Med 2019;14:173-8

How to cite this URL:
Tfayli AH, Fakhri GB, Al Assaad MS. Prevalence of the epidermal growth factor receptor mutations in lung adenocarcinoma patients from the Middle East region. Ann Thorac Med [serial online] 2019 [cited 2023 Mar 24];14:173-8. Available from:

Lung cancer continues to be the leading cause of cancer death in both men and women, claiming 1.59 million lives worldwide in 2012.[1],[2],[3] The estimated number of new lung cancer cases in 2018 is 234,030 in the US alone and it is projected that lung cancer remains the second most common cancer in males, after prostate cancer, and females, after breast cancer.[4] Cancer Registries from various countries in the Middle East area confirm the same findings, with lung cancer being one of the most common cancers in that region.[5],[6],[7] It ranks after prostate, colon and bladder for males, and after breast and cervical cancer for females. In males, the highest age-standardized incidence of lung cancer per 100,000 was reported in Palestine (40.4) followed by Tunisia (37.1), Bahrain (34.2), and Lebanon (31.8).[5],[6],[7] One reason for this high incidence of lung cancer is the high prevalence of tobacco smoking.[8],[9]

In contrast to the steady increase in survival observed for most cancer types, advances have been slow for lung cancer that is typically diagnosed at an advanced stage. The 5-year survival rate is 55% for cases detected when the disease is still localized, 27% for regional disease, and 4% for late-stage disease.[4],[10] Unfortunately, 70% of patients with nonsmall cell lung cancer (NSCLC) present at a later stage and are not eligible for surgery. There is strong evidence showing that the standard chemotherapy and supportive care can prolong overall survival, and improve quality of life, but prognosis remains poor, especially in patients with advanced stage NSCLC.[11],[12],[13],[14]

The recent discovery of driver mutations in lung adenocarcinomas has made significant changes in the diagnostic and therapeutic approach for this disease.[15],[16] Multiple studies have consistently shown that using targeted agents that specifically block a driver mutation leads to improved responses and survival as compared to standard chemotherapy.[14],[17] The most commonly described driver mutations in lung adenocarcinomas are Kirsten rat sarcoma viral oncogene homolog (KRAS), epidermal growth factor receptor (EGFR), and echinoderm microtubule associated protein-like 4 anaplastic lymphoma kinase (ALK) translocation. While KRAS is the most commonly described mutation; it, unfortunately, remains an elusive target with no drugs showing significant activity in patients whose tumor harbor that mutation. On the other hand, patients whose tumors have other mutations such as EGFR, ALK, mesenchymal-epithelial transition, and ROS-1, have derived significant benefit from agents that target these mutations.[18],[19],[20]

   Methodology Top

This review was conducted in early 2018. The search was conducted in accordance with the checklist of the Association of American Medical Colleges for review articles. The literature review is up to date and articles were critically appraised for validity and relevance. A comprehensive search was conducted in PubMed, Medline, and Google Scholar for the presence of gray literature. Articles were included if they were published in the English language, and reported the prevalence of the EGFR mutation rate in any country in the Arab World. No limitations were made on year of publication. The search strategy consisted of three concepts. The first concept regarding lung cancer was searched using the following terms: lung cancer, lung tumor, lung oncology, lung adenocarcinoma, or nonsmall cell. MeSH terms and keywords used for the concept of the EGFR consisted of: EGFR, epidermal growth factor, EGFR, EGFR mutation, or EGFR frequency. The last concept was regarding the region of interest and the MeSH terms and keywords used were: Middle East, Middle Eastern, Gulf, the Arab world, Arab country, or Levant. Our final search yielded six published articles that fit our eligibility criteria. Critical appraisal of all of the yielded articles was performed and a summary of the results is synthesized and summarized in [Table 1].
Table 1: Characteristics of patients tested for epidermal growth factor receptor mutations in the Arab world

Click here to view

   Results Top

Epidermal growth factor receptor mutations worldwide

Reports on EGFR prevalence are abundant worldwide with reports showing a wide variation of EGFR mutation frequency among different ethnic backgrounds and geographical locations. The variability arises from the different demographic characteristics of the participants, study designs, assays used to test for EGFR, number of sequenced exons, tumor source (primary or metastasis), and eligibility criteria for enrolment.[26],[27],[28],[29],[30],[31],[32],[33] A recent systematic review reported the spectrum of EGFR mutation frequencies in Europe, Asia, North America, India subcontinent, and South America. A table representing the pooled data from these regions compared to the Middle East is represented in [Figure 1].[34]
Figure 1: Epidermal growth factor receptor mutation frequencies from major regions worldwide

Click here to view

EGFR prevalence has been extensively studied in Asia. A recent review paper from China reported that EGFR mutations ranged between 24.5% and 43% in NSCLC and between 40.9% and 78% in adenocarcinomas. The majority of mutations were in exon 19 and 21 (45.7% and 48%, respectively).[16],[35] On the other hand, a recent Indian study reported EGFR mutation prevalence ranging from 5.3% to 45.4% among lung adenocarcinomas with the most frequent ones belonging to exons 19 and 21.[2]

In Europe, the European Tarceva versus chemotherapy study was the first prospective phase III trial of erlotinib versus chemotherapy in non-Asian patients with EGFR mutation–positive NSCLC. As part of their screening, 225 out of 1044 patients tested positive for either exon 19 or 21 suggesting a prevalence of 22%.[36],[37] In a 4200 patient cohort from Germany, 432 had a positive mutation in EGFR (10.3%).[33]

In a series from Memorial Sloan-Kettering Cancer Center, Dogan et al. reported an EGFR mutation rate of 20%.[26] As for patients who were African–American, a large-cohort study was conducted in 2012 in patients diagnosed with lung adenocarcinoma revealing an EGFR mutation of 19% with the majority (78%) being in exon 19 and the rest in exon 21. In 2014, the lung cancer mutation consortium published its report on using multiplexed assays testing adenocarcinomas of the lung for driver mutations in ten genes. In 1007 patients who participated in this trial, the frequency of EGFR was determined to be 21% with the majority belonging to exon 19.[38]

Epidermal growth factor receptor prevalence in the Arab world

The first paper to be published concerning EGFR mutation prevalence from the Middle East Area was reported in 2006. 47 NSCLC surgically-treated formalin-fixed paraffin-embedded (FFPE) tissues were analyzed between 1989 and 2003 in King Faisal Hospital in the Kingdom of Saudi Arabia (KSA). Samples were analyzed using a tissue microarray format for immunohistochemistry (IHC), fluorescent in situ hybridization (FISH), and DNA sequencing. Genetic analysis of the EGFR gene was performed using polymerase chain reaction (PCR) amplification of exon 18, 19, 20, and 21. IHC was performed using the EGFR antibody (20.005; Zymed/Invitrogen; Germany) to detect EGFR protein overexpression and membranous staining was considered positive. Of 43 tissues that were analyzed for IHC, 30 of them showed positivity for EGFR expression (69.8%). As for EGFR amplification testing using FISH, 6 out of 39 interpretable samples tested positive for EGFR amplification (15.3%). Sequencing was successful in 34 specimens and only one mutation (2.9%) was detected in exon 20 (R803 L). This study has multiple limitations including the small sample size and inclusion of nonadenocarcinoma cases.[21]

In 2013, and in an attempt to report, the frequency of EGFR mutations in Northern Africa, a study was reported from Morocco. Genetic analysis of 137 FFPE tumor tissues was performed using TaqMan PCR. A total of 29 EGFR mutations were detected (21%) with the most frequent EGFR aberration being in exon 19 (69%) followed by exon 21 (21%). The authors noted that the percentage of EGFR mutations was higher in women and never-smokers.[22]

The first endeavor to determine the frequency of EGFR in Lebanon was attempted by Fakhruddin et al. and was published in 2014. One hundred and six cases of NSCLC were selected for genetic testing using PCR kits that detect can 29 somatic mutations via the RotorGene-Q platform. EGFR mutations were detected in nine samples (8.5%) where eight of them belonged to a deletion in exon 19 and one case to the L858R locus in exon 21.[5] The second attempt to report EGFR mutation prevalence in Lebanon was completed and published in 2015.[23] Two hundred and one patients with NSCLC were included and had an EGFR mutation rate of 11.9%. The methodology utilized was the amplification refractory mutation system (ARMS) and Scorpions technology real-time PCR. Most of the mutations belonged to exon 19 deletions (48%), followed by exon 21 L858R missense mutation (40%) and exon 18 G719X mutation (4%). The majority of the patients were males (61.2%), and current or former smokers (78.1%); a result that fits the reported mutational profile of EGFR mutations in the West.

A large multisite study was published in 2015 extracting data about the prevalence of EGFR mutations from three different countries: KSA, United Arab Emirates and Qatar.[24] EGFR analysis was performed using PCR and 230 records were analyzed retrospectively for EGFR mutations and other clinical characteristics. Sixty-six patients harbored the EGFR mutation (28.7%) with the majority representing a deletion in exon 19 (54.5%) followed by exon 21 mutations (39.4%) with significant association with female gender, and smoking status (P < 0.01).

The first and most recent study of prospective nature was published in 2017 collecting information from nine different sites in Lebanon, Jordan, and Iraq. Patients represented a wide variety of nationalities: Lebanese, Syrian, Palestinian, Jordanian, and Iraqi. Tumor tissues for 205 patients were analyzed using the multiplex PCR ARMS and Scorpion method on the RotorGene-Q platform. The majority of the patients were men (66.2%), former or current smokers (72.4) with a mean age of 62.9 years at diagnosis. A mutation rate of 15.6% was reported with the majority belonging to exon 19 deletions (78.1%) followed by exon 21 L858R missense mutation (21.9%).[25]

   Discussion Top

EGFR is a transmembrane glycoprotein that is a member of the protein kinase superfamily. The EGFR gene is located on the short arm of chromosome 7 (7p11.2) and encodes a 170 kDa Type I transmembrane growth factor receptor with tyrosine kinase (TK) activity.[36],[39],[40],[41] EGFR belongs to the human epidermal growth factor receptor/erbB family of receptor TKs where homodimerization and/or heterodimerization in response to ligand binding activates the TK. This process causes auto-phosphorylation of the cytoplasmic domain of the receptor allowing it to interact with other molecules affecting downstream signaling pathways. This downstream EGFR signaling sequentially leads to increased proliferation, angiogenesis, and decreased apoptosis.[14],[21],[42],[43],[44],[45] The TK activity of EGFR may be dysregulated by several oncogenic mechanisms, such as EGFR gene mutation. Gain-of-function or activating mutations of the EGFR gene occur in some NSCLCs, leading to constitutive TK activity. These findings make EGFR a rational target for therapeutic intervention and support the development of novel anticancer agents that target EGFR.[46],[47],[48],[49],[50],[51],[52]

Assays for epidermal growth factor receptor testing

The standard method of testing of EGFR mutations is the direct sequencing of PCR-amplified DNA. This genomic DNA corresponds to exons 18–21 of the EGFR gene. The sensitivity of PCR testing is affected by the presence of noncancerous tissue in the sample. In addition to that, PCR testing is done using FFPE, and this, alone, can contribute to the artefacts in sequencing.[14],[53] To increase the sensitivity of the mutational assay described above, other methods were developed. The ARMS, combined with the Scorpion Amplified Refractory Mutation assay, has been commercially developed to detect mutated DNA from previously-identified known mutations and this usually requires more DNA than PCR would.[54] The most common EGFR mutations are small in-frame deletions in exon 19 and L858R missense mutations in exon 21 and together, these two mutations account for 90% of all EGFR mutations. The remaining 10% is represented by mutations in exon 18 and exon 20 such as G719A, G719S, and G719C in exon 18 and T790M and S7681 in exon 20 among many others.[21],[55],[56]

The prevalence of EGFR mutations varies according to gender, race, smoking history, and histology. EGFR mutations are reported to be more common in women, Asians, never-smokers, and in adenocarcinoma histology.[2],[11],[26],[27],[28],[29],[40] An inverse relationship has been suggested between the intensity or duration of smoking and frequency of EGFR mutation proposing that smoking history has a predictive value for EGFR mutations. There is an on-going controversy as to whether routine EGFR testing should be performed in the subset of patients perceived as having a low probability of mutation such as Caucasian male smokers.[26],[30],[31]

Collectively, these studies are crucial as they lead to the documentation of molecular driver mutations and establish the molecular complexity of NSCLC. As reported above, the frequencies for EGFR mutations in lung adenocarcinoma patients are markedly different among the Western, Asian, and Arab populations. This has raised the notion that ethnic variations and geographical locations alter the genomic background of lung tumors in addition to other demographic traits. This has prompted researchers in the Arab countries to report the prevalence of their sample populations.[5],[6],[7],[8],[21],[42] The prevalence of EGFR in Asia has reached 45.5%, whereas in Europe, the highest prevalence was reported as 22%. In the Arab countries area, the numbers ranged from 2.9% to 28.7% where the low-frequency report in the first publication can be explained by small sample size and testing methodology.[57],[58],[59]

The studies discussed above were conducted in the Arab countries to evaluate the prevalence of EGFR mutations in patients diagnosed with lung cancer and estimate the percentage of them who would benefit from EGFR-targeted therapy.[60] The reported EGFR mutation rates in the Arab countries are in the line of what is reported in Western populations ranging between 12% and 15% in the most recent series. The first study reported from Saudi Arabia has multiple limitations as discussed above. The study reported by Jazieh from the Gulf region was a retrospective collection of data on patients already tested for EGFR mutation. This automatically introduces selection bias because testing was initially being done on patients with a high likelihood of harboring the mutation. This is evident by the high percentage of nonsmokers on that study. The two series reported from Lebanon are more likely to reflect the true prevalence of EGFR mutations as the testing was being done on all comers with lung adenocarcinoma.

   Conclusion Top

The EGFR mutation frequencies in the Middle East remain slightly higher than the numbers reported from the Western countries. However, the highest mutation rates remain in the Asian population. More studies addressing EGFR mutations and subsequent therapy are needed in countries of the Middle East specifically and the Arab World generally.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

World Health Organization Cancer Fact Sheet; 2016. [Last Updated on 2018 Sep 12; Last accessed on 2018 Nov 10].  Back to cited text no. 1
Malik PS, Jain D, Kumar L. Epidermal growth factor receptor tyrosine kinase inhibitors in advanced non-small cell lung cancer. Oncology 2016;91 Suppl 1:26-34.  Back to cited text no. 2
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.  Back to cited text no. 3
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68:7-30.  Back to cited text no. 4
Fakhruddin N, Mahfouz R, Farhat F, Tfayli A, Abdelkhalik R, Jabbour M, et al. Epidermal growth factor receptor and KRAS mutations in lung adenocarcinoma: A retrospective study of the Lebanese population. Oncol Rep 2014;32:2223-9.  Back to cited text no. 5
Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010;19:1893-907.  Back to cited text no. 6
Salim EI, Moore MA, Al-Lawati JA, Al-Sayyad J, Bazawir A, Bener A, et al. Cancer epidemiology and control in the Arab world – Past, present and future. Asian Pac J Cancer Prev 2009;10:3-16.  Back to cited text no. 7
Shamsiddine A. Cancer trends in Lebanon and projections to 2020. Hum Health 2015;32:8-11.  Back to cited text no. 8
Lebanese National Cancer Registry. Lebanese Ministry of Public Health. Lebanese National Cancer Registry; 2015. Available from: [Last accessed on 2018 Nov 01].  Back to cited text no. 9
Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016;66:271-89.  Back to cited text no. 10
Zhang YL, Yuan JQ, Wang KF, Fu XH, Han XR, Threapleton D, et al. The prevalence of EGFR mutation in patients with non-small cell lung cancer: A systematic review and meta-analysis. Oncotarget 2016;7:78985-93.  Back to cited text no. 11
Non-Small Cell Lung Cancer Collaborative Group. Chemotherapy and supportive care versus supportive care alone for advanced non-small cell lung cancer. Ochrane Database Syst Rev 2010;12;(5).  Back to cited text no. 12
Cataldo VD, Gibbons DL, Pérez-Soler R, Quintás-Cardama A. Treatment of non-small-cell lung cancer with erlotinib or gefitinib. N Engl J Med 2011;364:947-55.  Back to cited text no. 13
da Cunha Santos G, Shepherd FA, Tsao MS. EGFR mutations and lung cancer. Annu Rev Pathol 2011;6:49-69.  Back to cited text no. 14
Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer 2012;12:252-64.  Back to cited text no. 15
Gou LY, Wu YL. Prevalence of driver mutations in non-small-cell lung cancers in the people's republic of China. Lung Cancer (Auckl) 2014;5:1-9.  Back to cited text no. 16
Cappuzzo F, Toschi L, Finocchiaro G, Ligorio C, Santoro A. Surrogate predictive biomarkers for response to anti-EGFR agents: State of the art and challenges. Int J Biol Markers 2007;22:10-23.  Back to cited text no. 17
Pao W, Girard N. New driver mutations in non-small-cell lung cancer. Lancet Oncol 2011;12:175-80.  Back to cited text no. 18
Weinstein IB. Cancer. Addiction to oncogenes – The Achilles heal of cancer. Science 2002;297:63-4.  Back to cited text no. 19
Scagliotti GV, Parikh P, von Pawel J, Biesma B, Vansteenkiste J, Manegold C, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 2008;26:3543-51.  Back to cited text no. 20
Al-Kuraya K, Siraj AK, Bavi P, Al-Jommah N, Ezzat A, Sheikh S, et al. High epidermal growth factor receptor amplification rate but low mutation frequency in Middle East lung cancer population. Hum Pathol 2006;37:453-7.  Back to cited text no. 21
Errihani H, Inrhaoun H, Boukir A, Kettani F, Gamra L, Mestari A, et al. Frequency and type of epidermal growth factor receptor mutations in Moroccan patients with lung adenocarcinoma. J Thorac Oncol 2013;8:1212-4.  Back to cited text no. 22
Naderi S, Ghorra C, Haddad F, Kourie HR, Rassy M, El Karak F, et al. EGFR mutation status in Middle Eastern patients with non-squamous non-small cell lung carcinoma: A single institution experience. Cancer Epidemiol 2015;39:1099-102.  Back to cited text no. 23
Jazieh AR, Jaafar H, Jaloudi M, Mustafa RS, Rasul K, Zekri J, et al. Patterns of epidermal growth factor receptor mutation in non-small-cell lung cancers in the gulf region. Mol Clin Oncol 2015;3:1371-4.  Back to cited text no. 24
Tfayli A, Rafei H, Mina A, Khalil M, Fakhreddin N, Mahfouz R, et al. Prevalence of EGFR and ALK mutations in lung adenocarcinomas in the Levant area – A prospective analysis Asian Pac J Cancer Prev 2017;18:107-14.  Back to cited text no. 25
Dogan S, Shen R, Ang DC, Johnson ML, D'Angelo SP, Paik PK, et al. Molecular epidemiology of EGFR and KRAS mutations in 3,026 lung adenocarcinomas: Higher susceptibility of women to smoking-related KRAS-mutant cancers. Clin Cancer Res 2012;18:6169-77.  Back to cited text no. 26
Shigematsu H, Lin L, Takahashi T, Nomura M, Suzuki M, Wistuba II, et al. Clinical and biological features associated with epidermal growth factor receptor gene mutations in lung cancers. J Natl Cancer Inst 2005;97:339-46.  Back to cited text no. 27
Gazdar AF. Activating and resistance mutations of EGFR in non-small-cell lung cancer: Role in clinical response to EGFR tyrosine kinase inhibitors. Oncogene 2009;28 Suppl 1:S24-31.  Back to cited text no. 28
Hantson I, Dooms C, Verbeken E, Vandenberghe P, Vliegen L, Roskams T, et al. Performance of standard procedures in detection of EGFR mutations in daily practice in advanced NSCLC patients selected according to the ESMO guideline: A large Caucasian cohort study. Transl Respir Med 2014;2:9.  Back to cited text no. 29
Pham D, Kris MG, Riely GJ, Sarkaria IS, McDonough T, Chuai S, et al. Use of cigarette-smoking history to estimate the likelihood of mutations in epidermal growth factor receptor gene exons 19 and 21 in lung adenocarcinomas. J Clin Oncol 2006;24:1700-4.  Back to cited text no. 30
Lee YJ, Shim HS, Kang YA, Hong SJ, Kim HK, Kim H, et al. Dose effect of cigarette smoking on frequency and spectrum of epidermal growth factor receptor gene mutations in Korean patients with non-small cell lung cancer. J Cancer Res Clin Oncol 2010;136:1937-44.  Back to cited text no. 31
Reinersman JM, Johnson ML, Riely GJ, Chitale DA, Nicastri AD, Soff GA, et al. Frequency of EGFR and KRAS mutations in lung adenocarcinomas in African Americans. J Thorac Oncol 2011;6:28-31.  Back to cited text no. 32
Schuette W, Schirmacher P, Eberhardt WE, Fischer JR, von der Schulenburg JM, Mezger J, et al. EGFR mutation status and first-line treatment in patients with stage III/IV non-small cell lung cancer in Germany: An observational study. Cancer Epidemiol Biomarkers Prev 2015;24:1254-61.  Back to cited text no. 33
Midha A, Dearden S, McCormack R. EGFR mutation incidence in non-small-cell lung cancer of adenocarcinoma histology: A systematic review and global map by ethnicity (mutMapII). Am J Cancer Res 2015;5:2892-911.  Back to cited text no. 34
Chen W, Zheng R, Zuo T, Zeng H, Zhang S, He J, et al. National cancer incidence and mortality in china, 2012. Chin J Cancer Res 2016;28:1-11.  Back to cited text no. 35
Rosell R, Carcereny E, Gervais R, Vergnenegre A, Massuti B, Felip E, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): A multicentre, open-label, randomised phase 3 trial. Lancet Oncol 2012;13:239-46.  Back to cited text no. 36
Benlloch S, Botero ML, Beltran-Alamillo J, Mayo C, Gimenez-Capitán A, de Aguirre I, et al. Clinical validation of a PCR assay for the detection of EGFR mutations in non-small-cell lung cancer: Retrospective testing of specimens from the EURTAC trial. PLoS One 2014;9:e89518.  Back to cited text no. 37
Kris MG, Johnson BE, Berry LD, Kwiatkowski DJ, Iafrate AJ, Wistuba II, et al. Using multiplexed assays of oncogenic drivers in lung cancers to select targeted drugs. JAMA 2014;311:1998-2006.  Back to cited text no. 38
Douillard JY, Ostoros G, Cobo M, Ciuleanu T, McCormack R, Webster A, et al. First-line gefitinib in Caucasian EGFR mutation-positive NSCLC patients: A phase-IV, open-label, single-arm study. Br J Cancer 2014;110:55-62.  Back to cited text no. 39
Krawczyk P, Ramlau R, Chorostowska-Wynimko J, Powrózek T, Lewandowska MA, Limon J, et al. The efficacy of EGFR gene mutation testing in various samples from non-small cell lung cancer patients: A multicenter retrospective study. J Cancer Res Clin Oncol 2015;141:61-8.  Back to cited text no. 40
Mok TS, Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009;361:947-57.  Back to cited text no. 41
Giaccone G, Herbst RS, Manegold C, Scagliotti G, Rosell R, Miller V, et al. Gefitinib in combination with gemcitabine and cisplatin in advanced non-small-cell lung cancer: A phase III trial – INTACT 1. J Clin Oncol 2004;22:777-84.  Back to cited text no. 42
Razis E, Skarlos D, Briasoulis E, Dimopoulos M, Fountzilas G, Lambropoulos S, et al. Treatment of non-small cell lung cancer with gefitinib ('Iressa', ZD1839): The Greek experience with a compassionate-use program. Anticancer Drugs 2005;16:191-8.  Back to cited text no. 43
Amann J, Kalyankrishna S, Massion PP, Ohm JE, Girard L, Shigematsu H, et al. Aberrant epidermal growth factor receptor signaling and enhanced sensitivity to EGFR inhibitors in lung cancer. Cancer Res 2005;65:226-35.  Back to cited text no. 44
Herbst RS, Giaccone G, Schiller JH, Natale RB, Miller V, Manegold C, et al. Gefitinib in combination with paclitaxel and carboplatin in advanced non-small-cell lung cancer: A phase III trial – INTACT 2. J Clin Oncol 2004;22:785-94.  Back to cited text no. 45
Herbst RS, Heymach JV, Lippman SM. Lung cancer. N Engl J Med 2008;359:1367-80.  Back to cited text no. 46
Gu J, Zhou Y, Huang L, Ou W, Wu J, Li S, et al. TP53 mutation is associated with a poor clinical outcome for non-small cell lung cancer: Evidence from a meta-analysis. Mol Clin Oncol 2016;5:705-13.  Back to cited text no. 47
Halvorsen AR, Silwal-Pandit L, Meza-Zepeda LA, Vodak D, Vu P, Sagerup C, et al. TP53 mutation spectrum in smokers and never smoking lung cancer patients. Front Genet 2016;7:85.  Back to cited text no. 48
Westcott PM, To MD. The genetics and biology of KRAS in lung cancer. Chin J Cancer 2013;32:63-70.  Back to cited text no. 49
Zappa C, Mousa SA. Non-small cell lung cancer: Current treatment and future advances. Transl Lung Cancer Res 2016;5:288-300.  Back to cited text no. 50
Wells A. EGF receptor. Int J Biochem Cell Biol 1999;31:637-43.  Back to cited text no. 51
De Luca A, Carotenuto A, Rachiglio A, Gallo M, Maiello MR, Aldinucci D, et al. The role of the EGFR signaling in tumor microenvironment. J Cell Physiol 2008;214:559-67.  Back to cited text no. 52
Marchetti A, Felicioni L, Buttitta F. Assessing EGFR mutations. N Engl J Med 2006;354:526-8.  Back to cited text no. 53
Newton CR, Graham A, Heptinstall LE, Powell SJ, Summers C, Kalsheker N, et al. Analysis of any point mutation in DNA. The amplification refractory mutation system (ARMS). Nucleic Acids Res 1989;17:2503-16.  Back to cited text no. 54
Weir BA, Woo MS, Getz G, Perner S, Ding L, Beroukhim R, et al. Characterizing the cancer genome in lung adenocarcinoma. Nature 2007;450:893-8.  Back to cited text no. 55
Motoi N, Szoke J, Riely GJ, Seshan VE, Kris MG, Rusch VW, et al. Lung adenocarcinoma: Modification of the 2004 WHO mixed subtype to include the major histologic subtype suggests correlations between papillary and micropapillary adenocarcinoma subtypes, EGFR mutations and gene expression analysis. Am J Surg Pathol 2008;32:810-27.  Back to cited text no. 56
Lynch TJ, Bell DW, Sordella R, Gurubhagavatula S, Okimoto RA, Brannigan BW, et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med 2004;350:2129-39.  Back to cited text no. 57
Paez JG, Jänne PA, Lee JC, Tracy S, Greulich H, Gabriel S, et al. EGFR mutations in lung cancer: Correlation with clinical response to gefitinib therapy. Science 2004;304:1497-500.  Back to cited text no. 58
Pao W, Miller V, Zakowski M, Doherty J, Politi K, Sarkaria I, et al. EGF receptor gene mutations are common in lung cancers from “never smokers” and are associated with sensitivity of tumors to gefitinib and erlotinib. Proc Natl Acad Sci U S A 2004;101:13306-11.  Back to cited text no. 59
Kim YT, Kim TY, Lee DS, Park SJ, Park JY, Seo SJ, et al. Molecular changes of epidermal growth factor receptor (EGFR) and KRAS and their impact on the clinical outcomes in surgically resected adenocarcinoma of the lung. Lung Cancer 2008;59:111-8.  Back to cited text no. 60


  [Figure 1]

  [Table 1]

This article has been cited by
1 Exosomes from EGFR-Mutated Adenocarcinoma Induce a Hybrid EMT and MMP9-Dependant Tumor Invasion
Amina Jouida, Marissa O’Callaghan, Cormac Mc Carthy, Aurelie Fabre, Parthiban Nadarajan, Michael P. Keane
Cancers. 2022; 14(15): 3776
[Pubmed] | [DOI]
2 EGFR T751_I759delinsN Mutation in Exon19 Detected by NGS but Not by Real-Time PCR in a Heavily-Treated Patient with NSCLC
Zi-Ting Chang, Tien-Ming Chan, Chiao-En Wu
International Journal of Molecular Sciences. 2022; 23(21): 13451
[Pubmed] | [DOI]
3 Molecular Epidemiology of the Main Druggable Genetic Alterations in Non-Small Cell Lung Cancer
Sara S. Fois, Panagiotis Paliogiannis, Angelo Zinellu, Alessandro G. Fois, Antonio Cossu, Giuseppe Palmieri
International Journal of Molecular Sciences. 2021; 22(2): 612
[Pubmed] | [DOI]
4 Exosomes: a new perspective in EGFR-mutated lung cancer
Amina Jouida, Cormac McCarthy, Aurelie Fabre, Michael P. Keane
Cancer and Metastasis Reviews. 2021; 40(2): 589
[Pubmed] | [DOI]
5 Targeting alveolar macrophages shows better treatment response than deletion of interstitial macrophages in EGFR mutant lung adenocarcinoma
Kristina Alikhanyan, Yuanyuan Chen, Simone Kraut, Rocio Sotillo
Immunity, Inflammation and Disease. 2020; 8(2): 181
[Pubmed] | [DOI]


Print this article  Email this article
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (492 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Figures
    Article Tables

 Article Access Statistics
    PDF Downloaded418    
    Comments [Add]    
    Cited by others 5    

Recommend this journal