EGFR Mutation Testing From the Pathologist’s Point of View
Ka Fai To, MBChBChairman and Professor
Department of Anatomical and Cellular Pathology The Chinese University of Hong Kong
Honorary Chief of ServiceDepartment of Anatomical and Cellular Pathology
Prince of Wales HospitalAssociate Director
State Key Laboratory in Oncology in South China
EGFR = epidermal growth factor receptor
Yang PC, et al. ASCO 2012. Abstract 1534.
EGFR Mutation Frequency in Different Populations
CountryEGFR Mutation-
Positive Rate Percentage of
PatientsChina 372/741 50.2%Hong Kong 76/161 47.2%India 16/72 22.2%Philippines 34/65 52.3%Taiwan 108/174 62.1%Thailand 63/117 53.8%Vietnam 77/120 64.2%
EGFR Mutation Frequency by Sex
SexEGFR Mutation-
Positive Rate Percentage of
Patients
Male 362/822 44.0%
Female 384/628 61.1%
Yang PC, et al. ASCO 2012. Abstract 1534.
EGFR Mutation Frequency by Smoking Status
Smoking StatusEGFR Mutation-
Positive Rate Percentage of
PatientsNever smoker 462/761 60.7%
Heavy smokers (50 packs/year) NA 31.4%
Sex and Smoking Status
Male never smoker 104/184 56.5%
Female never smoker 358/577 62.0%
Male regular smoker 113/301 37.5%
Female regular smoker 8/23 34.8%
Yang PC, et al. ASCO 2012. Abstract 1534.
EGFR Mutation Frequency by Disease Stage
Yang PC, et al. ASCO 2012. Abstract 1534.
Disease StageEGFR Mutation-
Positive Rate Percentage of
PatientsIIIB 117/271 43.2%
IV 612/1144 53.5%
Other 17/35 48.6%
Female Male
Local Hong Kong Data: Prince of Wales Hospital, Hong Kong, China
Disease Stage
EGFR Mutation Status Cannot Be Determined by Population Characteristics• Ideally, oncologists first seeing their patients with
newly diagnosed advanced-stage NSCLC already have the EGFR mutation data to facilitate their choice of an optimal treatment plan for a particular patient.
– Require reflex EGFR mutation testing
NSCLC = non-small cell lung cancer
Rationale for Reflex EGFR Mutation Testing
• Availability of suitable tumor samples→Reflex EGFR mutation testing would help to assess the
adequacy of tumor sample at the time of pathological diagnosis
• After making a request for EGFR mutation testing, time required for:
– Transportation of sample to EGFR mutation testing molecular laboratory
– Laboratory turn-around time for the EGFR mutation testing
→Reflex EGFR mutation testing would shorten the time and would not delay the treatment decision.
Barriers to Reflex EGFR Mutation Testing
• Recognition of the benefits of reflex EGFR mutation testing
• Adequacy of tumor samples for EGFR mutation testing
• Availability of EGFR mutation testing service
• Reimbursement issues
Multidisciplinary Management Is Crucial
• Pulmonologists, cardiothoracic surgeon, radiologists, oncologist, and pathologists
→Right drug to the right patient at the right time
Pathologists: Key Role in Optimized EGFR Mutation Analysis
• Pathological diagnosis– Making a diagnosis of primary NSCLC is not adequate– Subtype NSCLC into adenocarcinoma, squamous cell carcinoma, etc.– Test all lung cancers with adenocarcinoma component
• Ensure best possible samples for diagnostic and molecular biomarker studies
• Assessment of sample adequacy for molecular testing (microdissection to enrich tumor cell content if required)
• Select the appropriate EGFR mutation testing platform• Provide the EGFR mutation testing result in a timely fashion
Only an EGFR mutation test will confirm or exclude the possibility
of EGFR mutation.
Thank you for participating in this activity.
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