adenocarcinoma stage 4 exon 20 mutation - 1263489

4301kj
Posts:2

My wifes pathology just came it with the exon 20 mutation, I have searched for any treatments that impact this and have had little success...can anyone help me out?

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Reply # - April 29, 2014, 01:04 PM

JimC
Posts: 2753

Hi 4301kj,

As Dr. Pennell points out in his post "EGFR Mutations Demystified" (http://cancergrace.org/lung/2009/03/20/np-egfr-muts-demystified/ ), cancer driven by an exon 20 mutation tends to be resistant to EGFR TKIs such as Tarceva. Dr. West has discussed how he treats such patients here: http://cancergrace.org/lung/2013/02/13/cip-egfr-exon-20-mutation/

JimC
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Reply # - April 29, 2014, 01:34 PM

4301kj
Posts: 2

Jim C, thank you for pointing me to Dr. Wests treatment discussions. Is there a way to follow up with Dr. West to understand how the patient he treated with Tarceva did after his posting from February, 2013? Do I contact him somehow on this site?

Reply # - April 29, 2014, 09:56 PM

Dr West
Posts: 4735

Not remarkably well. Overall, since then, there is only a little more evidence that exon 20 mutations are not typically great responders to EGFR inhibitors. The best evidence, scant though it is, is that people with an exon 20 mutation are likely better served by being treated as if they have no EGFR mutation -- namely, starting with conventional chemo and then potentially giving Tarceva (erlotinib) as a later line of therapy. It might be helpful, but exon 20 mutations don't follow the same rule of "EGFR TKI is clearly the optimal therapy" that is pretty clear for exon 19 or exon 21 mutations in the EGFR gene.

Good luck.

-Dr. West

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