Double trouble: a case of concurrent de novo T790M and L858R EGFR mutations in treatment-naive advanced non-small-cell lung cancer
Saxena, A.; Nagasaka, M.; Li, Z.; Becker, D.J.; Levy, B.P.
Oncology 28(6): 526; 528 530, 534
2014
ISSN/ISBN: 0890-9091 PMID: 25134330 Document Number: 12118
T790M mutations develop as a mechanism of resistance after initial TKI therapy for sensitizing EGFR mutations. Management of rare de novo mutations remains controversial. In double-mutation patients with both de novo T790M and sensitizing EGFR mutations, first-line treatment with a reversible TKI may not be optimal, particularly when the population of T790M-mutant cells may be detected by more sensitive molecular techniques. In these cases, cytotoxic chemotherapy may offer the best chance for response, although afatinib may have activity. As molecular mutation testing is integrated more fully into clinical practice, and as detection methods become more sensitive, oncologists are likely to encounter more patients with double mutations. We await further studies addressing the role of other treatment options, including second- and third-generation TKI therapies, which may help improve outcomes.
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