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Are EGFR mutations primarily a concern among Asian populations?
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No, they are not.
People tend to think of EGFR mutations as an Asian phenomenon. This is true in the sense that there are more EGFR mutations found in Asian regions, but it is not uncommon to identify these mutations in non-smoking patients and in patients with adenocarcinoma who are not of Asian descent.
The proportion of patients with EGFR mutations in the Western population is about 15%. So finding these mutations in Western populations is not that rare.
We need a paradigm shift that will change the mentality and understanding of the patient pharmocogenomic, so that clinicians can treat each patient appropriately based on their mutation status. This shift in thinking is a step forward that needs to be taken together, by clinicians in the East and in the West.
The paradigm shift requires that we move forward together to look for mutations and subsequently make progress toward determining the most appropriate treatment. We should not view mutations in a way that suggests this is an Eastern disease. It is crucial for clinicians worldwide to work together toward the common goal of better treatment for our patients.
Tony S. K. Mok, MD, is a Professor in the Department of Clinical Oncology at The Chinese University of Hong Kong.
They are a larger concern for Asian patients.
In general, we know that EGFR mutations are more common among women, never smokers, patients with adenocarcinoma-type lung cancer and those of East Asian ethnicity. It is rare among squamous-type lung cancer. The rate of EGFR mutations is definitely higher in Asians. Overall, about 30% of Asians with NSCLC have an EGFR mutation, including Chinese, Korean and Japanese patients. Compared with non-Asians, it is also higher among Asian smokers and ex-smokers. The mechanism behind the differences of EGFR mutation rates among different ethnicities is still unclear and is the subject of intense research. Data on mutation rates are not available for other ethnicities.
It is clear that patients with EGFR mutant tumors have greater response to the class of drugs that were developed to inhibit specifically the biochemical activities of EGFR. As more and more mutations that lung cancer cells are addicted to for growth are being discovered, and as these mutations are shown to influence the choice or effect of treatment prescribed, we are seeing the new age of cancer medicine, in which molecular testing will become part of routine diagnosis for lung cancer and also all other types of cancer.
Ming-Sound Tsao, MD, is a Pathologist, Senior Scientist and M. Qasim Choksi Chair in Lung Cancer Translational Research at the Princess Margaret Hospital and a Professor of Laboratory Medicine and Pathobiology at the University of Toronto.