A clinically certified gene expression profile improved survival in a cohort of patients with stage I-IIA NSCLC by identifying those likely to benefit from adjuvant intervention, independent of epidermal growth factor receptor (EGFR) status alone, according to a study published in Clinical Lung Cancer. Evaluating a prospective cohort of patients with early-stage NSCLC (n = 250), researchers compared EGFR mutation data to molecular risk stratification. Patients with stage I-IIA non-squamous NSCLC underwent prospective molecular risk stratification by the 14-gene prognostic assay. Platinum doublet adjuvant chemotherapy (AC) was recommended for patients considered molecular high-risk (MHR). Differences in freedom from recurrence (FFR) and disease-free survival (DFS) were evaluated. At 29 months, prospective molecular testing yielded estimated FFRs of 94.6% and 72.4% in low-risk and untreated patients who were MHR, respectively, and 97.0% among patients who were MHR receiving AC. In contrast, there was no association between EGFR status and recurrence, while molecular risk predicted survival and response to AC within both the EGFR mutation+ and mutation- populations. Sixty-seven percent of patients who were EGFR+ and 49% of those who were EGFR- were molecular low-risk patients. Researchers pointed out that basing adjuvant intervention in early-stage NSCLC on EFGR status alone may undertreat up to 51% of EGFR- patients likely to benefit from adjuvant intervention, and overtreat as many as 67% of EGFR+ patients more likely to be free of residual disease.
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