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Background Epidermal growth factor receptor (EGFR) gene mutations identify patients with non-small cell lung cancer (NSCLC) who have a high likelihood of benefiting from treatment with anti-EGFR tyrosine kinase inhibitors. Sanger sequencing is widely used for mutation detection but can be technically challenging, resulting in longer turn-around-time, with limited sensitivity for low levels of mutations. This manuscript details the technical performance verification studies and external clinical reproducibility studies of the cobas EGFR Mutation Test, a rapid multiplex real-time PCR assay designed to detect 41 mutations in exons 18, 19, 20 and 21. Methods The assay’s limit of detection was determined using 25 formalin-fixed paraffin-embedded tissue (FFPET)-derived and plasmid DNA blends. Assay performance for a panel of 201 specimens was compared against Sanger sequencing with resolution of discordant specimens by quantitative massively parallel pyrosequencing (MPP). Internal and external reproducibility was assessed using specimens tested in duplicate by different operators, using different reagent lots, instruments and at different sites. The effects on the performance of the cobas EGFR test of endogenous substances and nine therapeutic drugs were evaluated in ten FFPET specimens. Other tests included an evaluation of the effects of necrosis, micro-organisms and homologous DNA sequences on assay performance, and the inclusivity of the assay for less frequent mutations. Results A >95% hit rate was obtained in blends with >5% mutant alleles, as determined by MPP analysis, at a total DNA input of 150 ng. The overall percent agreement between Sanger sequencing and the cobas test was 96.7% (negative percent agreement 97.5%; positive percent agreement 95.8%). Assay repeatability was 98% when tested with two operators, instruments, and reagent lots. In the external reproducibility study, the agreement was > 99% across all sites, all operators and all reagent lots for 11/12 tumors tested. Test performance was not compromised by endogenous substances, therapeutic drugs, necrosis up to 85%, and common micro-organisms. All of the assessed less common mutations except one (exon 19 deletion mutation 2236_2248 > AGAC) were detected at a similar DNA input level as that for the corresponding predominant mutation. Conclusion The cobas EGFR Mutation Test is a sensitive, accurate, rapid, and reproducible assay.

e23251Background: The cobas EGFR Mutation Test v2 (cobas EGFR test) is a real-time PCR test for the qualitative detection of 42 mutations in exons 18, 19, 20, and 21 of the epidermal growth factor ...

EGFR mutations identify patients with NSCLC who have a high likelihood of benefiting from first-line treatment with anti-EGFR tyrosine kinase inhibitors. Sanger sequencing is widely used for mutation detection but can be time-consuming, and has limited sensitivity for low levels of mutations. We describe the analytic performance of the cobas EGFR Mutation Test, a multiplex, 3-reaction real-time PCR assay designed to detect 41 mutations in exons 18, 19, 20 and 21. The mutations detected and the mutation report calls are listed below: The amount of DNA required for the assay (150 ng) can typically be isolated from a single 5-micron FFPET section, and the test can be performed in < 8 hours. Analytic sensitivity was assessed using DNA blends from NSCLC FFPET tumor sections. A >95% hit rate was obtained in blends with >5% mutant alleles for L858R and exon 19 deletions as determined by 454 sequencing (quantitative massively parallel pyrosequencing) at a total DNA input of 150ng, or 50 ng per PCR amplification. The cobas test was compared to 2x bidirectional Sanger sequencing using a set of 152 NSCLC FFPET specimens. The overall percent agreement (OPA) between the 2 methods was 96.7% (negative agreement - NPA 97.5%; positive agreement - PPA 95.8%). Specimens with discordant cobas EGFR Test and Sanger results were analyzed by 454 and a revised agreement analysis was performed based on the composite results of the 3 assays. The revised OPA was 98.7% (NPA 98.8%; PPA 98.6%). The call repeatability of a panel of NSCLC FFPET specimens was 98% when tested with two operators, instruments, and reagent lots. Necrotic tissue, hemoglobin, triglycerides, and common respiratory organisms did not interfere with the assay. The test showed no cross reactivity with the corresponding exon sequences from the HER2, HER3, and HER4 genes. These analytic studies demonstrate that the cobas EGFR Mutation Test is a sensitive, accurate and reproducible assay. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1707. doi:1538-7445.AM2012-1707