Mark Kris, MD: Lacking Actionable Mutations in NSCLC

What treatment options do you consider in the first-line setting for patients such as Robert, who lack actionable mutations such as EGFR, ALK?

This scenario is a fairly common one where initial testing has been done, did not reveal EGFR or ALK. I think the first question is, is the person a candidate for additional mutational testing, and, in general, it’s always a yes for that. This case happens to be a large cell cancer, but, again, even in that case, many of these large cell cancers have characteristics of squamous or adenocarcinoma, and you need to have additional pathological testing as well as additional mutational testing. The other key question is do you stop the procedure and do an additional biopsy, and, in general, I would say yes as long as the patient was fit and as long as this is something that’s agreeable with the patient. While you’re waiting for those additional mutational results to come, again, it’s a decision based on the condition of the patient.

mNSCLC: Case 1

RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month’s duration. He is a former smoker and quit approximately 30 years ago.

Chest X-ray in October 2015 showed a large mass in the upper left lobe and CT scan showed a left pleural effusion and enlargement of the left mediastinal and hilar lymph node.

MRI of the brain was negative for intracranial metastases.

The patient underwent resection of the primary mass which showed large cell carcinoma. Pleural fluid was tapped and also positive.

His lung cancer was staged as 4. His biopsy was sent for molecular testing and showed no actionable mutations in EGFR or ALK.

His current performance status is 1.