A Patient With Metastatic Lung Adenocarcinoma Harboring Concurrent EGFR L858R, EGFR Germline T790M, and PIK3CA Mutations: The Challenge of Interpreting Results of Comprehensive Mutational Testing in Lung Cancer

Mutational testing has moved to the forefront as an integral component in the management of patients with non–small cell lung cancer (NSCLC). Currently 3 targeted therapies (erlotinib, afatinib, and crizotinib) are approved by the FDA to treat patients with specific genetic abnormalities in NSCLC. As mutational screening expands to include a greater number of genes, the results will become more difficult to interpret, particularly if mutations are found in multiple genes or genes that are not actionable at the time of testing. This case report summarizes the diagnosis and treatment of a patient with NSCLC that harbored multiple potentially targetable driver mutations. It also discusses the current NCCN Clinical Practice Guidelines in Oncology for mutational testing in NSCLC and the inherent difficulties with interpreting mutational results when multiple mutations are found in a single gene or across multiple genes.

Target Audience

This activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Summarize the diagnosis and treatment of a patient with NSCLC that harbored multiple potentially targetable driver mutations
  • Explain the role of multiplexed gene sequencing platforms and next-generation sequencing testing in tailoring effective treatments to individual patients
  • Discuss examples showing that it is difficult to plan effective treatment for a patient with multiple potentially targetable driver mutations
     
Additional information
Supporters: 

No commercial support was received for this article.

Course summary
Available credit: 
  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician
Course opens: 
01/23/2014
Course expires: 
01/23/2015
Cost:
$0.00

Philip E. Lammers, MD
Division of Hematology and Oncology
Vanderbilt University Medical Center and
Vanderbilt Ingram Cancer Center
Nashville, Tennessee

Christine M. Lovly, MD
Division of Hematology and Oncology
Vanderbilt University Medical Center and
Vanderbilt Ingram Cancer Center
Nashville, Tennessee

Leora Horn, MD, MSc
Department of Medicine
Division of Hematology and Oncology
Vanderbilt University Medical Center and
Vanderbilt Ingram Cancer Center
Nashville, Tennessee

Available Credit

  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician

Accreditation Period

Course opens: 
01/23/2014
Course expires: 
01/23/2015

Price

Cost:
$0.00
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Required Hardware/software

To access this activity, users will need:

  • A device with an Internet connection
  • Adobe Reader or other PDF reader software for article and certificate viewing/printing