J Clin Oncol. 2012 Jul 2. [Epub ahead of print]
Timing of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Therapy in Patients With Lung Cancer With EGFR Mutations.
Source
Catalan Institute of Oncology, Hospital Germans Trias i Pujol and Universitat Autonoma de Barcelona, Barcelona, Spain; Massachusetts General Hospital, Boston, MA.
Abstract
A 45-year-old never-smoking woman was referred for a consultation about additional management of her recently diagnosed stage IV lung adenocarcinoma. The diagnosis was suspected on the basis of a chest X-ray (CXR) obtained for additional evaluation of dry cough and dyspnea. The CXR and subsequent computed tomography (CT) -scan revealed a left upper lobe mass and multiple, smaller bilateral nodules. The diagnosis was confirmed with percutaneous CT-guided fine-needle aspiration and 20-gauge core needle biopsy of the left upper lobe mass, which revealed adenocarcinoma. Immunohistochemical stains were positive for CK7 and negative for CK20 and thyroid transcription factor-1, consistent with pulmonary origin. Staging evaluation including positron emission tomography-CT confirmed the CXR findings, but no disease was detected outside the thorax. EGFR, KRAS, and ALK genotyping had been ordered and was still pending at the time of the consultation. Because of the symptoms, the patient and her referring physician were anxious to start therapy. The oncologist recommended standard chemotherapy with carboplatin, pemetrexed, and bevacizumab and administered cycle 1 without difficulty.(1,2) Ten days after starting chemotherapy, the results of the genotyping returned and revealed a deletion mutation in EGFR exon 19.
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