부산대학교 도서관

Introduction: The incidence of oesophageal cancer (OC) is increasing. Targeted therapies are being investigated, as chemotherapy in advanced OC achieves only 50% response rates and confers significant toxicity. TRANS-COG is a sub-study of COG, the only randomised trial of the Epidermal Growth Factor Receptor (EGFR) tyrosine kinase inhibitor (TKI) gefitinib versus placebo in patients with advanced OC. Aim and Methods: The aim of TRANS-COG is to identify biomarkers for predicting response to gefitinib by investigating the frequency of mutations of EGFR pathway members and EGFR gene copy number gain (CNG) by Fluorescence In Situ Hybridisation (FISH). Results: No EGFR mutations were identified, frequency of other pathway member mutations are as follows: KRAS 3.6%, PI3KCA 3.2%, BRAF 0.6%. The frequency of EGFR CNG was 13.5%. There were two cases of combined EGFR CNG and KRAS mutation 0.3%.Patients with EGFR CNG tumours had improved OS with gefitinib compared to placebo, log rank p=0.033, HR 0.523 (95%CI 0.285-0.962). Those with EGFR high CNG (amplification) also had improved OS with gefitinib, median OS 4.40 months vs median OS 1.71 months for placebo log rank p=0.004, HR 0.184 (95% CI 0.052-0.653). Mutation of KRAS conferred poor prognosis, independent of treatment received; median OS 3.614 months in KRAS wild type vs 1.741 months in KRAS mutated tumours, log rank p=0.023, HR 1.8153 (95% CI 1.078 3.187). A novel KRAS codon 61 mutation, Q61L, was also identified. Conclusion: 21.18% of patients have dysregulation of the EGFR pathway, these abnormalities represent realistic therapeutic targets. This analysis demonstrates clinical utility of EGFR CNG as a predictive biomarker of gefitinib response.