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Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Rapidly fatal advanced EGFR-mutated lung cancers and the need for rapid tumor genotyping in clinical practice
Deepa Rangachari1, Lauren Drake1, Mark S Huberman1
1Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA, USA.
Abstract:
Use of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is associated with dramatic, durable, and tolerable responses and side effect profiles when applied for palliation of advanced EGFR-mutated non-small-cell lung cancers (NSCLCs). Expert guidelines recommend that EGFR mutation testing results should be available within 10 working days of receipt of tumor specimen by the testing laboratory; in circumstances where the tumor specimen needs to be sent to an external laboratory for testing, the sample should be sent within 3 working days of receiving the request for testing. We report here 2 cases, out of 109 EGFR-mutated (exon 19 deletion or L858R) NSCLCs seen at our institution, experiencing rapid clinical deterioration and death within the window of time prescribed by consensus testing guidelines. We hypothesize that a faster turn-around time may have changed the clinical outcome. Improving rapid turnaround times for tumor genotyping may afford more optimal palliation vis-à-vis early initiation of oral targeted therapy in patients with advanced EGFR-mutated NSCLC.
Insights
Faster epidermal growth factor receptor (EGFR) mutation testing for advanced non-small-cell lung cancer (NSCLC) may improve patient outcomes. Timely results can enable earlier targeted therapy, potentially preventing rapid clinical deterioration.
Area of Science:
- Oncology
- Molecular Diagnostics
- Thoracic Surgery
Background:
- Advanced non-small-cell lung cancer (NSCLC) with EGFR mutations responds well to tyrosine kinase inhibitors (TKIs).
- Current guidelines recommend EGFR mutation test results within 10 working days, with external sample submission within 3 days.
Purpose of the Study:
- To investigate the impact of turnaround time for EGFR mutation testing on patient outcomes in advanced NSCLC.
- To highlight cases where delays in testing may have affected clinical outcomes.
Main Methods:
- Retrospective analysis of 109 patients with EGFR-mutated NSCLC.
- Review of clinical data for patients experiencing rapid deterioration within guideline timelines.
Main Results:
- Two cases of rapid clinical deterioration and death occurred within the recommended EGFR testing window.
- These cases suggest a potential link between delayed testing and adverse outcomes.
Conclusions:
- Improving turnaround times for EGFR genotyping may lead to earlier initiation of targeted therapy.
- Faster testing could potentially improve palliation and clinical outcomes for patients with advanced EGFR-mutated NSCLC.
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