The Role of EGFR Mutations in Non-Small-Cell Lung Cancer Treatments (2024)

EGFR, epidermal growth factor receptor, is a protein found on the surface of your cells that makes them grow.

If you have non-small cell lung cancer (NSCLC), your cancer might carry certain changes, or mutations, in your EGFR gene. Those changes make the protein made from this gene act in ways it shouldn’t.

When that happens, your EGFR gets stuck “on.” That makes your cells grow faster. It’s important to note that EGFR is one of many mutations that can drive your cancer’s growth.

Who Has NSCLC With EGFR Mutations?

About 1 in 10 of all people with NSCLC have an EGFR mutation, but it’s more common in some groups.

For example, about 1 in 3 Asian people with NSCLC have EGFR mutations.

It’s even more common in people who have lung cancer but never smoked. About half of those lung cancer cases have an EGFR mutation.

If your NSCLC has this change, it’s known as EGFR-positive. Having this mutation may affect your treatment options, especially if your cancer is more advanced.

Your doctor will likely treat your cancer using drugs that target EGFR, although you may have surgery or chemotherapy, too.

How Will My Cancer’s EGFR Status Affect My Lung Cancer Treatment?

Your doctor will help you decide the best way to treat your NSCLC based on many factors, including your cancer’s EGFR status. Your doctor will consider:

  • Your general health and age
  • The type of your lung cancer
  • The stage of your lung cancer
  • Whether your cancer can be removed with surgery
  • Whether your cancer has spread to distant parts of your body
  • Whether your cancer has come back after earlier treatment
  • Whether your cancer has features that make it more likely to respond to immunotherapy
  • Whether your cancer has certain changes in genes, including EGFR, for which there are approved targeted treatments or clinical trials

Your EGFR status is an important consideration as you and your doctor choose the best way to treat your cancer.

Your cancer’s EGFR status will matter most when your NSCLC has spread to distant parts of your body. When your lung cancer remains localized or hasn’t spread very far, a surgeon may be able to remove it with surgery.

If it is caught early and can be removed fully with surgery, the specific type of cancer and mutations it has won’t change your treatment or outlook. But most lung cancers aren’t caught at this early stage.

What Are the Treatments for EGFR-Positive Lung Cancer?

If you have advanced or stage IV NSCLC with EGFR-positive status, your doctor will likely treat your cancer with a targeted therapy.

These medicines are called EGFR inhibitors, or EGFR-targeted tyrosine kinase inhibitors (TKIs). These drugs block the EGFR signal that makes your cancer cells grow.

If you have stage III lung cancer and you’re eligible for surgery, your doctor may have you take an EGFR inhibitor after surgery.

EGFR inhibitors most often used for advanced stage IV NSCLC include:

  • Afatinib
  • Dacomitinib
  • Erlotinib
  • Gefitinib
  • Osimertinib

Osimertinib is approved for both early and more advanced EGFR-positive lung cancers.

You might take erlotinib along with another medicine called ramucirumab, which helps slow your cancer growth by blocking new blood vessels from forming.

If your advanced EGFR-positive NSCLC is a type known as squamous NSCLC, your doctor may use an EGFR inhibitor called necitumumab along with chemotherapy.

Your doctor will help you decide which EGFR inhibitor to try first. It’ll depend on:

  • Your doctor’s preferences
  • Your preferences and goals
  • Other conditions you have
  • Your lung cancer and its EGFR mutations

What if I Have a Less Common EGFR Mutation?

NSCLC can have different EGFR mutations. Your EGFR test results will tell your doctor what specific type of EGFR mutation your lung cancer has.

About 10%-15% of NSCLCs have a mutation that makes them more likely to respond to treatment with one of the more commonly used EGFR inhibitors or TKIs.

For NSCLCs with less common EGFR mutations, the specific mutation could lead to changes in how you’re treated. One of these less common EGFR mutations is called an exon 20 insertion. About 2% of NSCLCs and 10% of EGFR-positive NSCLCs are this type.

Earlier, doctors used chemotherapy for this type of EGFR-positive NSCLC. Your doctor may still use chemo to treat it at first. But now there are targeted treatments for this type of EGFR mutation.

In 2021, the FDA approved amivantamab-vmjw, an EGFR and MET bispecific antibody, for advanced NSCLC with EGFR exon 20 mutations. It's approved for use if your SCLC with an EGFR exon 20 insertion keeps growing after chemotherapy.

What About Immunotherapy?

Immunotherapiesare treatments that work by helping your immune system fight cancer. They’ve led to big improvements for some people with NSCLC.

However, immunotherapy often doesn’t work well for treating EGFR-positive NSCLC. Scientists don’t really know why.

Studies are ongoing to understand this better and find even more ways to treat EGFR-positive NSCLC.

What Is the Treatment Outlook for EGFR-Positive Lung Cancer?

EGFR inhibitors can help you live longer if you have an advanced NSCLC that has EGFR mutations.

Treatment can help slow your cancer for months or years, but it won’t cure your cancer.

One reason is that cancers treated with targeted therapy tend to find ways to resist treatment over time. Your cancer may pick up new mutations that enable it to keep growing despite treatment with EGFR inhibitors.

If this happens to you, your doctor might test your cancer again to see if it has mutations that might respond to a different targeted therapy. They might test it to see if it responds to immunotherapy or some other treatment.

You also may want to consider enrolling in a clinical trial that tests new treatments or new treatment combinations for EGFR-positive NSCLC.

The Role of EGFR Mutations in Non-Small-Cell Lung Cancer Treatments (2024)

FAQs

What is the role of EGFR mutation in lung cancer? ›

EGFR (epidermal growth factor receptor) is a protein on cells that helps them grow. A mutation in the gene for EGFR can make it grow too much, which can cause cancer. There are different types of EGFR mutations.

How is EGFR mutation treated in non-small cell lung cancer? ›

EGFR inhibitors that target cells with an exon 20 mutation: Amivantamab (Rybrevant) in combination with chemo (carboplatin and pemetrexed). Amivantamab is a monoclonal antibody (a lab-made version of a specific immune system protein) that targets two proteins that help cancer cells grow: EGFR and MET.

What are the EGFR mutations in NSCLC patients? ›

Doctors group EGFR mutations in NSCLC into four types:
  • Classical EGFR mutations, which include the most common types: EGFR 19 deletions and EGFR L858R point mutations.
  • EGFR exon 20 insertions.
  • T790M-like mutations.
  • P-loop αC-helix compression (PACC) mutations.
Oct 11, 2023

What is the survival rate of EGFR mutation lung cancer? ›

Researchers found that following treatment with EGFR inhibitors, the survival rates for people with EGFR mutation lung adenocarcinoma were: 95.6% after a year. 74% after 2 years.

What is EGFR treatment in cancer? ›

EGFR therapy refers to medications that bind to the EGFR protein and help to slow or stop cell growth. EGFR is present on the surface of some cells and can cause cells to divide when epidermal growth factor binds to it. Examples of EGFR therapy drugs include afatinib, dacomitinib, erlotinib, gefitinib, and osimertinib.

What is the standard of care for EGFR mutated NSCLC? ›

Front-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) therapy is the standard of care for lung cancer patients with sensitising EGFR mutations (exon 19 deletion or L858R mutation).

Can you live a long time with EGFR lung cancer? ›

Our case demonstrates that it is possible to achieve long-term survival in advanced EGFR-mutated NSCLC with multiple BMs and systemic progression through a reasonable therapeutic schedule.

What is the best treatment for non-small cell lung cancer? ›

The most common treatments for non small cell lung cancer are: surgery. radiotherapy. chemotherapy.

Is EGFR lung cancer aggressive? ›

In these cancers, growth isn't related to a mutation but to EGFR amplification, which causes rapid growth and results in highly aggressive tumors.

What cancers are caused by EGFR mutation? ›

EGFR Mutation is present in 5.48% of AACR GENIE cases, with lung adenocarcinoma, conventional glioblastoma multiforme, glioblastoma, colon adenocarcinoma, and non-small cell lung carcinoma having the greatest prevalence [4].

What are the most frequent EGFR mutations? ›

EGFR mutations occur in several hotspots between exons 18 and 21. In-frame deletion of exon 19 and L858R point mutation in exon 21 are the most common types of mutations detected, and account for 50% and 40% of patients' samples, respectively [8].

What does EGFR do? ›

The estimated glomerular filtration rate (eGFR) is a test that measures your level of kidney function and determines your stage of kidney disease. Your healthcare team can calculate it from the results of your blood creatinine test, your age, body size, and gender.

What are the odds of beating non-small cell lung cancer? ›

Outlook / Prognosis

This means that 63% of people diagnosed with the condition are still alive five years later. The five-year survival rate for regional NSCLC (when the cancer has spread to nearby tissues or lymph nodes) is 35%. With metastatic non-small cell lung cancer, the five-year survival rate is 7%.

Is EGFR mutation good or bad? ›

EGFR is short for epidermal growth factor receptor. It's a protein that helps cells grow, and it's found on both healthy cells and cancer cells. A mutation in this gene can cause cells to reproduce at an extremely high rate, which can lead to cancer.

How long can you live with stage 4 lung cancer on Tagrisso? ›

In the clinical trial, half the adults who took TAGRISSO + chemotherapy (pemetrexed and platinum-based chemotherapy) lived at least 25.5 months without their cancer growing or spreading and half the adults who took TAGRISSO alone lived at least 16.7 months without their cancer growing or spreading.

Why do they test for EGFR in lung cancer? ›

This test is helpful to direct therapy. It detects the presence of mutations in the EGFR gene in the DNA of the tumor cells to help determine whether someone with non-small cell lung cancer (NSCLC) may benefit from targeted therapy with tyrosine kinase inhibitors (TKIs) such as gefitinib or erlotinib.

What is Lungcancer EGFR mutation? ›

EGFR's job is to help cells grow and divide. In the case of EGFR-positive non small cell lung cancer (NSCLC), a mutation, or damage, in a gene causes the EGFR to remain stuck in the “on” position. This “drives” abnormal cell growth, which is what cancer is.

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