EGFR Testing in Squamous Cell Carcinoma of the Lung

[DrMetal]

Is it true that we don't do EGFR Testing in Squamous Cell Carcinoma of the Lung? True according to NCCN: https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf (slide 17). But I thought we do EGFR testing in all non-small cell lung CA ?

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[bobow98]

We do - the rates are low indeed for EGFR in SCC for lung but these days many of us are running NGS on a solid tumor panel; it's included.

 

[DrMetal]

We do - the rates are low indeed for EGFR in SCC for lung but these days many of us are running NGS on a solid tumor panel; it's included.

That's what I thought. I get it that the rates are low. But if positive for EGFR in SCC, you would offer a TKI right?

 

[gutonc]

That's what I thought. I get it that the rates are low. But if positive for EGFR in SCC, you would offer a TKI right?

Is this a board question or a real life question?

Boards: No
Real life: Just get FoundationOne or some other NGS panel and then give chemo anyway since it will all be negative.

 

[DrMetal]

Is this a board question or a real life question?

Boards: No
Real life: Just get FoundationOne or some other NGS panel and then give chemo anyway since it will all be negative.

Was inquiring about both. MKSAP tends to suggest you never check EGFR in squamous... I remember checking it for all non-small cell (including squamous) in clinic. Thanks.

 

[gutonc]

Was inquiring about both. MKSAP tends to suggest you never check EGFR in squamous... I remember checking it for all non-small cell (including squamous) in clinic. Thanks.

MKSAP is right, for the boards.

I've had this discussion with roughly 90% of the new, or progressing patients, that I've seen in the last month or six.

Me: So, your disease is not responding to therapy line X anymore.
Them: Well, what do we do now?
Me: If you were a test question, this would be easy. The answer is 'B'...moar chemo!1!1!1! But you're a real person, with X, Y and Z comorbidities. So all the chemo options I have will guarantee you a miserable death in the ICU sometime in the next 2 or 3 weeks. And I'm not down with that. But if you are, I can refer you to the private group in town, they'd love to treat you.

On a somewhat related note, I've been in my current position for 8 years now. Only in the last 6 months have we gotten path to stop checking EGFR/ROS/ALK on every single thing that came out of the lung.
- 1.2cm TTF1+ adeno with 27 neg LNs in a lobectomy specimen? EGFR/ROS/ALK tested.
- 5cm low-grade NET/typical carcinoid in a lobectomy? EGFR/ROS/ALK tested...and negative.
- Core needle bx of a lung mass in a 38yo woman w/ a h/o triple neg breast cancer that shows invasive lobular carcinoma? EGFR/ROS/ALK tested and negative. But try getting them to send ER/PR and HER2 FISH.
- Mediastinoscopy for diffuse thoracic LAD. CD20+, CD19+ monoclonal lymphoid population c/w DLBCL. EGFR/ROS/ALK tested and negative.