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.
Show Sources
Photo Credit: shapecharge / Getty Images
SOURCES:
Lung Cancer Foundation of America: “What is EGFR-positive lung cancer and how is it treated?”
American Lung Association: “EGFR and Lung Cancer.”
Annals of Oncology: “Overview of current systemic management of EGFR-mutant NSCLC.”
Therapeutic Advances in Medical Oncology: “Treatment choice in epidermal growth factor receptor mutation-positive non-small cell lung carcinoma: latest evidence and clinical implications.”
Memorial Sloan Kettering Cancer Center: “Lung Cancer Genomic Testing (EGFR, KRAS, ALK).”
National Cancer Institute: “Targeted Therapy to Treat Cancer.”
CDC: “How Is Lung Cancer Diagnosed and Treated?”
National Cancer Institute Surveillance, Epidemiology, and End Results Program: “Cancer Stat Facts: Lung and Bronchus Cancer.”
American Health & Drug Benefits: “Portrazza (Necitumumab), an IgG1 Monoclonal Antibody, FDA Approved for Advanced Squamous Non–Small-Cell Lung Cancer.”
Translational Lung Cancer Research: “Treatment of uncommon EGFR mutations in non-small cell lung cancer: new evidence and treatment.”
American Society of Clinical Oncology: “Targeted Therapy for Non-Small Cell Lung Cancer with an EGFR Exon 20 Insertion.”
FDA: “FDA grants accelerated approval to mobocertinib for metastatic non-small cell lung cancer with EGFR exon 20 insertion mutations,” “FDA grants accelerated approval to amivantamab-vmjw for metastatic non-small cell lung cancer.”
Frontiers in Oncology: “Immunotherapy in Treating EGFR-Mutant Lung Cancer: Current Challenges and New Strategies.”
Biomedicines: “Amivantamab-Vmjw: A Novel Treatment for Patients with NSCLC Harboring EGFR Exon 20 Insertion Mutation after Progression on Platinum-Based Chemotherapy.”
Japanese Journal of Clinical Oncology: “Current treatment strategies for EGFR-mutated non-small cell lung cancer: from first line to beyond osimertinib resistance.”
