Introduction Personalised treatments are becoming increasingly important in medicine, and the use of tyrosine kinase inhibitors (TKI) in the management of the subset of patients with pulmonary adenocarcinomas which express a mutation in the epidermal growth factor receptor (EGFR), is one example of this approach. However, although this cell type is common, in the UK only a small proportion of patients express the EGFR mutation and there is little published data on the number of patients receiving TKI therapy. Since 2010 we have routinely performed EGFR testing on pulmonary adenocarcinoma samples at our large cancer unit and were interested to assess our use of TKIs.
Methods We reviewed all cases of pulmonary adenocarcinoma since EGFR testing began, looking for the proportion EGFR positive, their performance state (PS), and what treatments were offered.
Results Of 241 cases of primary pulmonary adenocarcinoma, 54 (22%) had insufficient material available for mutation testing. Of the remaining 187, 23 (12%) were EGFR positive (mean age 76 [range 47–92], 18 female). Although 16 were PS ≤2, only 5 patients had stage 1A cancer with 13 having advanced disease (stage 3B/4). Seven patients underwent attempted curative surgery and 4 patients with poor PS were managed with best supportive care only. Twelve patients (52% of the EGFR positive group and 6.4% of the tested cohort) received a TKI (mean age 74 [50–92], PS ≤2 in 8, 10 female), and in 3 of these it was the only treatment modality offered (1%).
Conclusions We have shown that our cohort of patients with adenocarcinoma had a higher rate of EGFR mutation than expected, and that half of these received targeted biological therapy with tyrosine kinase inhibitors. Importantly TKI therapy was the only treatment modality available for patients who would have previously been untreated. This work emphasises the need to obtain a histological diagnosis in patients with lung cancer, to ensure that all possible treatment modalities can be considered.
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