Lung Cancer Gene Mutations

All patients with stage IV NSCLC who have the most common type, called adenocarcinoma, should have their tumor tested for at least two mutations prior to treatement. These mutations are called EGFR and ELM4-ALK and mutually exclusive (they don't ever occur together). Patients who have the EGFR mutation should be treated with a drug called Tarceva, while those who have the ELM4-ALK mutation should be treated with a relatively new comer, called Crizotinib. This is a new era in lung cancer where we are able to identify a mutation and treat with a drug targeting the mutation, rather than standard chemotherapy. Keep in mind only 15% of patients with adenocarcinoma will have the EGFR mutation and even less have the ELM4-ALK mutation (3-5%), so chances are that you will not have the mutation. Once the mutation is identified and you are treated with the appropriate drug, the mutation does not need to be tested again. That said, there is a significant interest in rebiopsying patients who progress (their tumor grows) on the drugs mentioned above (Tarceva or Crizotinib) to see if the mutation in the tumor has changed to something different. This is being done in clinical trials but is not, to date, considered the standard of care. So, in short, once your tumor has been identified as having the mutation and you are started on the drug, it does not need to be tested again unless part of a clinical trial and you progress on the drug. All patients with stage IV NSCLC who have the most common type, called adenocarcinoma, should have their tumor tested for at least two mutations prior to treatement. These mutations are called EGFR and ELM4-ALK and mutually exclusive (they don't ever occur together). Patients who have the EGFR mutation should be treated with a drug called Tarceva, while those who have the ELM4-ALK mutation should be treated with a relatively new comer, called Crizotinib. This is a new era in lung cancer where we are able to identify a mutation and treat with a drug targeting the mutation, rather than standard chemotherapy. Keep in mind only 15% of patients with adenocarcinoma will have the EGFR mutation and even less have the ELM4-ALK mutation (3-5%), so chances are that you will not have the mutation. Once the mutation is identified and you are treated with the appropriate drug, the mutation does not need to be tested again. That said, there is a significant interest in rebiopsying patients who progress (their tumor grows) on the drugs mentioned above (Tarceva or Crizotinib) to see if the mutation in the tumor has changed to something different. This is being done in clinical trials but is not, to date, considered the standard of care. So, in short, once your tumor has been identified as having the mutation and you are started on the drug, it does not need to be tested again unless part of a clinical trial and you progress on the drug.