For patients with metastatic adenocarcinoma of the lung, do you base any treatment decisions on EGFR gene amplification?

There are no proven predictive uses for EGFR amplification in lung cancer. In a negative trial of necitmumab, patients with EGFR amplification had a positive outcome in the EGFR amplified subset, but this was an unplanned analysis and is thus hypothesis generating rather than proven. The hypothesis has not been further tested. For patients with EGFR mutations, many have EGFR amplification, but this has not been established as an additional predictive biomarker over mutation alone.

Not at this time. When decoding the molecular reports for our patients with NSCLC, the relevant EGFR changes are limited to mutations. Overexpression and amplification have not been useful predictive markers for our current EGFR directed therapies. In fact, amplification of wild type EGFR may even drive resistance for some of our patients with EGFR-mutant NSCLC (Nukaga, Cancer Res 2017), though how frequently this occurs still needs to be clarified. For now, I take note but do not alter my treatment plan based on amplification.