1. EGFR Mutation Testing From the Pathologist’s Point of View
Ka Fai To, MBChB
Chairman and Professor Department of Anatomical and Cellular Pathology
The Chinese University of Hong Kong
Honorary Chief of Service Department of Anatomical and Cellular Pathology
Prince of Wales Hospital
Associate Director
State Key Laboratory in Oncology in South China

2. EGFR Mutation Frequency in Different Populations
Country
EGFR Mutation-Positive Rate
Percentage of Patients
China
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 = epidermal growth factor receptor
Yang PC, et al. ASCO Abstract 1534.

3. EGFR Mutation Frequency by Sex
EGFR Mutation-Positive Rate
Percentage of Patients
Male
362/822
44.0%
Female
384/628
61.1%
Yang PC, et al. ASCO Abstract 1534.

4. EGFR Mutation Frequency by Smoking Status
EGFR Mutation-Positive Rate
Percentage of Patients
Never 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 Abstract 1534.

5. EGFR Mutation Frequency by Disease Stage
EGFR Mutation-Positive Rate
Percentage of Patients
IIIB
117/271
43.2% IV
612/1144
53.5%
Other
17/35
48.6%
Yang PC, et al. ASCO Abstract 1534.

6. Local Hong Kong Data: Prince of Wales Hospital, Hong Kong, China
Female
Male
Disease Stage

7. 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

8. 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.

9. 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

10. Multidisciplinary Management Is Crucial
Pulmonologists, cardiothoracic surgeon, radiologists, oncologist, and pathologists
Right drug to the right patient at the right time

11. 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

12. Only an EGFR mutation test will confirm or exclude the possibility of EGFR mutation.

13. Thank you for participating in this activity.