title: Rapidly fatal advancedEGFR-mutated lung cancers and the need for rapid tumor genotyping in clinical practice.
abstract: Use of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is associated with dramatic, durable, and tolerable responses and side effect profiles when applied for palliation of advancedEGFR-mutated non-small-cell lung cancers (NSCLCs). Expert guidelines recommend thatEGFRmutation testing results should be available within 10 working days of receipt of tumor specimen by the testing laboratory; in circumstances where the tumor specimen needs to be sent to an external laboratory for testing, the sample should be sent within 3 working days of receiving the request for testing. We report here 2 cases, out of 109EGFR-mutated (exon 19 deletion or L858R) NSCLCs seen at our institution, experiencing rapid clinical deterioration and death within the window of time prescribed by consensus testing guidelines. We hypothesize that a faster turn-around time may have changed the clinical outcome. Improving rapid turnaround times for tumor genotyping may afford more optimal palliation vis-à-vis early initiation of oral targeted therapy in patients with advancedEGFR-mutated NSCLC.
authors.affiliation: Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA, USA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Rangachari
authors.affiliation: Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Drake
authors.affiliation: Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Huberman
authors.affiliation: Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA, USA.
authors.forename: Danielle C
authors.initials: DC
authors.lastname: McDonald
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: VanderLaan
authors.affiliation: Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Folch
authors.affiliation: Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Costa
keywords: EGFR; NSCLC; TKI; afatinib; erlotinib; gefitinib