Predictive and Prognostic Significance of Serum Neuron-Specific Enolase in Patients with Metastatic Non-Small Cell Lung Cancer Receiving Gefitinib: A Prospective Study from South Egypt Cancer Institute

Abdalla, Ashraf Zeidan; Khallaf, Salah Mabrouk; Mohammed, Doaa Abdelsamee; Mounir, Matta Gerges; Mohammed, Abdallah Hedia

doi:10.31557/APJCP.2025.26.7.2627

Predictive and Prognostic Significance of Serum Neuron-Specific Enolase in Patients with Metastatic Non-Small Cell Lung Cancer Receiving Gefitinib: A Prospective Study from South Egypt Cancer Institute

Document Type : Research Articles

Authors

¹ Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.

² Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.

10.31557/APJCP.2025.26.7.2627

Abstract

Background: Lung cancer remains the most lethal cancer in the world. Several predictive and prognostic biomarkers for non-small cell lung cancer (NSCLC) have emerged. Serum neuron-specific enolase (NSE) has been found to be elevated in up to 70% of patients with NSCLC. Prior retrospective studies have demonstrated conflicting results regarding the predictive and prognostic significance of baseline serum NSE in patients with metastatic NSCLC harboring epidermal growth factor receptor (EGFR) mutations who received tyrosine kinase inhibitors (TKIs). Our study aimed to evaluate the predictive and prognostic roles of pre-treatment serum NSE in patients with metastatic EGFR-mutated NSCLC planned to receive gefitinib therapy. Methods: In this prospective cohort study, we enrolled patients with known metastatic EGFR-mutated lung adenocarcinoma who presented at the Medical Oncology and Hematological Malignancies Department, South Egypt Cancer Institute (SECI), Assiut University; during the period from January 1st, 2021 to December 31st, 2022; and were planned to receive gefitinib therapy. Pre-treatment serum NSE was measured. The cut-off date of our study was July 31st, 2024. Association of baseline serum NSE level with therapy response and survival outcomes was analysed. Result: Forty eligible patients were enrolled. The median baseline serum NSE level was 9.0 ng/ml (range 6.0 – 15.3). Patients with high pre-treatment serum NSE level (higher than median level) were associated with significantly higher T and N clinical stages versus those with normal level (equal or less than median level). Regarding response rates, disease control rates (DCR) were significantly higher among those with normal serum NSE; whereas objective response rates (ORR) were similar in both groups. In terms of survival outcomes, high pre-treatment serum NSE was associated with worse progression-free survival (PFS) and overall survival (OS) outcomes. Conclusion: Baseline serum NSE is an independent poor predictive and prognostic factor for patients with metastatic EGFR-mutated NSCLC receiving gefitinib therapy.

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