Unearthing EGFR Mutations and the Rewards of Persistence in Precision Oncology: Breaching the 10-Year Survival Barrier in Metastatic NSCLC With Active Disease

Management of advanced/metastatic nonsquamous non–small-cell lung cancer (NSCLC) has undergone remarkable transformation in the recent past. With the advent of targeted therapy against specific genetic alterations and programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs), treatment algorithms have become increasingly complex. This complexity is highlighted in 2 patients we recently encountered in our lung cancer clinic. Consent for publication was obtained from both patients described in this Case Report.

[1]  Jian-yong Ding,et al.  Strategies to overcome acquired resistance to EGFR TKI in the treatment of non-small cell lung cancer , 2019, Clinical and Translational Oncology.

[2]  J. Kolesar,et al.  Potential Utility of Liquid Biopsy as a Diagnostic and Prognostic Tool for the Assessment of Solid Tumors: Implications in the Precision Oncology , 2019, Journal of clinical medicine.

[3]  B. Halmos,et al.  Response to Dual Crizotinib and Osimertinib Treatment in a Lung Cancer Patient with MET Amplification Detected by Liquid Biopsy Who Acquired Secondary Resistance to EGFR Tyrosine Kinase Inhibition. , 2018, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[4]  P. Laurent-Puig,et al.  Current and Future Molecular Testing in NSCLC, What Can We Expect from New Sequencing Technologies? , 2018, Journal of clinical medicine.

[5]  C. Dziri,et al.  Liquid Biopsy as Surrogate to Tissue in Lung Cancer for Molecular Profiling: A Meta-Analysis , 2018, Current respiratory medicine reviews.

[6]  B. Sundaram,et al.  Molecular Testing Guideline for the Selection of Patients With Lung Cancer for Treatment With Targeted Tyrosine Kinase Inhibitors: American Society of Clinical Oncology Endorsement of the College of American Pathologists/International Association for the Study of Lung Cancer/Association for Molecula , 2018, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  Robyn L. Temple-Smolkin,et al.  Updated Molecular Testing Guideline for the Selection of Lung Cancer Patients for Treatment With Targeted Tyrosine Kinase Inhibitors: Guideline From the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. , 2018, Archives of pathology & laboratory medicine.

[8]  Edward S. Kim,et al.  Update on EGFR Mutational Testing and the Potential of Noninvasive Liquid Biopsy in Non–Small‐cell Lung Cancer , 2017, Clinical lung cancer.

[9]  Navneet Singh,et al.  P2.03-053 A Five-Year Audit of EGFR and ALK Testing at a Tertiary Care Centre in North India: More Sensitive Methods Do Make a Difference! , 2017 .

[10]  X. Y. Zhang,et al.  Combination therapy of erlotinib/crizotinib in a lung adenocarcinoma patient with primary EGFR mutation plus secondary MET amplification and a novel acquired crizotinib-resistant mutation MET G1108C. , 2017, Annals of oncology : official journal of the European Society for Medical Oncology.

[11]  T. Mitsudomi,et al.  Tumor immune microenvironment and nivolumab efficacy in EGFR mutation-positive non-small-cell lung cancer based on T790M status after disease progression during EGFR-TKI treatment , 2017, Annals of oncology : official journal of the European Society for Medical Oncology.

[12]  M. Reck,et al.  PD-1 Axis Inhibition in EGFR Positives: A Blunt Sword? , 2017, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[13]  V. Gebski,et al.  Checkpoint Inhibitors in Metastatic EGFR‐Mutated Non–Small Cell Lung Cancer—A Meta‐Analysis , 2017, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[14]  J. Hainsworth,et al.  Efficacy of bevacizumab plus erlotinib versus erlotinib alone in advanced non-small-cell lung cancer after failure of standard first-line chemotherapy (BeTa): a double-blind, placebo-controlled, phase 3 trial , 2011, The Lancet.

[15]  R. Herbst,et al.  Phase II study of efficacy and safety of bevacizumab in combination with chemotherapy or erlotinib compared with chemotherapy alone for treatment of recurrent or refractory non small-cell lung cancer. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  Lesley Seymour,et al.  Erlotinib in lung cancer - molecular and clinical predictors of outcome. , 2005, The New England journal of medicine.

[17]  Renato Martins,et al.  Erlotinib in previously treated non-small-cell lung cancer. , 2005, The New England journal of medicine.