Urine test for EGFR analysis in patients with non-small cell lung cancer

The identification of activating and tyrosine kinase inhibitor (TKI)-sensitizing epidermal growth factor receptor (EGFR) mutations just over a decade ago transformed the clinical management of patients with non-small cell lung cancer (NSCLC) (1,2). The presence of EGFR L858R and exon 19 deletion mutants, among others, is observed in approximately a third of patients with NSCLC and is associated with a profound response to first-generation EGFR inhibitors such as erlotinib, gefitinib, and afatinib (3,4). For instance, erlotinib was approved for the first-line treatment of advanced NSCLC patients harboring EGFR activating mutations based on results from a randomized, multicenter, open-label trial (n=174) indicating a progression-free survival (PFS) benefit of 10.4 versus 5.2 months and an objective response rate (ORR) of 65% versus 16% with erlotinib compared to platinum-based doublet chemotherapy (5,6). As such, current clinical practice guidelines recommend the upfront testing for EGFR and other actionable oncogenic gene alterations, such as ALK and ROS1 rearrangements and BRAF mutations, in patients with NSCLC presenting with adenocarcinomas