Expert Point of View: Biomarker Analysis of the TORCH Study: First-line Erlotinib Only in Patients with EGFR-positive Non–Small Cell Lung Cancer

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Tetsuya Mitsudomi, MD, PhD, of Aichi Cancer Center Hospital in Nagoya, Japan, discussed the study presented by Tsao and colleagues1 and said that many previous trials have already shown that EGFR mutation is the most reliable predictive marker for treatment with EGFR tyrosine kinase inhibitors. The current analysis confirmed the importance of EGFR mutation testing when considering the use of erlotinib (Tarceva), especially in consideration of the shorter progression-free survival obtained with erlotinib when the mutation was absent. Consequently, although it was thought that erlotinib is active even in lung cancer patients without EGFR mutation if compared with gefitinib (Iressa), this study suggests that erlotinib should be avoided when treating patients without EGFR mutation, at least in the first-line setting. ■

Disclosure: Dr. Mitsudomi reported no potential conflicts of interest.


1. Tsao MS, Gallo C, Saieg M, et al: Biomarkers of TORCH trial of first-line erlotinib followed by second-line chemotherapy in advanced non-small cell lung cancer patients. European Lung Cancer Conference. Abstract 163O. Presented April 19, 2012.