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Med. Sci. 2017, 5(4), 34; doi:10.3390/medsci5040034

Histologic Grade Is Predictive of Incidence of Epidermal Growth Factor Receptor Mutations in Metastatic Lung Adenocarcinoma

1
Internal Medicine Residency Program, Kaiser Permanente, Santa Clara, CA 95051, USA
2
Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA
3
Division of Oncology and Hematology, Kaiser Permanente, Vallejo, CA 94589, USA
4
Department of Oncology and Hematology, Kaiser Permanente, Santa Clara, CA 95051, USA
*
Author to whom correspondence should be addressed.
Received: 24 October 2017 / Revised: 2 December 2017 / Accepted: 7 December 2017 / Published: 11 December 2017
(This article belongs to the Section Cancer and Cancer-Related Research)
View Full-Text   |   Download PDF [360 KB, uploaded 12 December 2017]   |  

Abstract

Activating epidermal growth factor receptor (EGFR) mutations in metastatic non-small cell lung cancer (NSCLC) are associated with a high response rate to EGFR tyrosine kinase inhibitor (TKI). The current guidelines recommend routine EGFR mutational analysis prior to initiating first line systemic therapy. The clinical characteristics including smoking status, histologic type, sex and ethnicity are known to be associated with the incidence of EGFR mutations. We retrospectively analyzed 277 patients with metastatic NSCLC within Kaiser Permanente Northern California (KPNC); among these patients, 83 were positive for EGFR mutations. We performed both univariate and multivariable logistic regressions to identify predictors of EGFR mutations. We found that histologic grade was significantly associated with the incidence of EGFR mutation, regardless of ethnicity, sex and smoking status. In grade I (well differentiated) and II (moderately differentiated), histology was associated with significantly higher incidence of EGFR mutations compared to grade II–III (moderate-to-poorly differentiated) and III (poorly differentiated). Ever-smokers with grade III lung adenocarcinoma had 1.8% incidence of EGFR mutations. This study indicates that histologic grade is a predictive factor for the incidence of EGFR mutations and suggests that for patients with grade II–III or III lung adenocarcinoma, prompt initiation of first-line chemotherapy or immunotherapy is appropriate while awaiting results of EGFR mutational analysis, particularly for patients with history of smoking. View Full-Text
Keywords: EGFR mutation; lung adenocarcinoma; histologic grade; NSCLC; erlotinib EGFR mutation; lung adenocarcinoma; histologic grade; NSCLC; erlotinib
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Levy, M.; Lyon, L.; Barbero, E.; Wong, J.; Suga, J.M.; Sam, D.; Pan, M. Histologic Grade Is Predictive of Incidence of Epidermal Growth Factor Receptor Mutations in Metastatic Lung Adenocarcinoma. Med. Sci. 2017, 5, 34.

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