Analysis of EGFR mutations in non-small cell lung carcinoma patients visiting Nepal Cancer Hospital and Research Center

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Tobacco smoking is the major cause for lung cancer, and Nepal is not an exception. Approximately 29.3% of men and 26.2% of women in Nepal smoke tobacco. A recent retrospective cross sectional study showed that while the majority, 50.53%, of male patients were highly prevalent with respiratory cancer, this proportion was minority in females (14.48%). Among respiratory cancers in males, lung cancer constituted about 60.42% Majority of lung cancer cases in Nepal were NSCLC- squamous cell carcinoma (45.23%), adenocarcinoma (16.66%) and large cell carcinoma (9.52%). Only 23.8% of lung cancers were small cell carcinoma. It has been reported that 90% of lung Adenocarcinomas show mutations in EGFR, a tyrosine kinase. Therefore, Gifitinib, a tyrosine kinase inhibitor, seems to be the best first line of chemotherapeutic agents to treat lung adenocarcinoma specifically. However, Gefitinib remains the widely used chemotherapeutic agent against all NSCLC cases in Nepal, indicating the existence of non- specific treatment cases. This raises the question whether Gefitinib treatment, as the first line, would be effective in all cases of lung cancer. Hence, it is essential to study the EGFR mutational profile in lung cancer patients to deliver specific chemotherapy. A retrospective study on the response of Gefitinib in NSCLC patients showed that after one month of treatment 38% and 6.6% of patients with adenocarcinoma and squamous cell Carcinoma of the lung respectively responded to Gefitinin therapy. However, this study had unknown EGFR status. Since there have been relapsed cases due to threonine to methionine amino acid change at position 790 of EGFR, following responsive Gifitinib treatment, it is crucial to know the EGFR profile in patients before administering Gifitinib.
To our knowledge, besides epidemiological and retrospective studies, no studies have been done at the molecular level to study EGFR mutational profile in the Nepalese NSCLC patients population. While most of the countries had established their own prevalence rate of EGFR mutation, until date there is no report on the prevalence of EGFR mutation in the NSCLC population in Nepal. Therefore we proposed to study EGFR mutation in lung cancer patients visiting Nepal cancer hospital and research Center and Bhaktapur Cancer Hospital. Bronchoscopy-based biopsy samples will be used, from where DNA will be extracted, amplified in the region of interest, and sequenced to check the mutation for EGFR.

Funding body: South Asian University (SAU), NewDelhi, India.
Funding year: 2016
Principal Investigator: Yuba Raj Pokharel, PhD., Institute of South Asian Studies, SAU
Co-Principal Investigators: Bijay Bajracharya, PhD., Bivek Timilsina, MSc., Center for Health and Disease Studies Nepal (CHDS-Nepal)
Co-Principal Investigators: Dr. Sudip Shrestha, MD. And Dr. Hari Dhakal, MD., Nepal
Cancer Hospital and Research Center (NCHRC)
Co-Principal Investigator: Dr. Mohan Devbhandari, MS., Bhaktapur Cancer Hospital (BCH)
Status: Incomplete due to lack of samples
Status: Close