EGFR status and smokers - 1263554

Hi deltaforce,

The chances of having an EGFR mutation decrease in proportion to how heavy and recent a patient's smoking history has been. Thus, the highest percentages of EGFR mutations are found in never-smoking patients, and the smallest in current, heavy smokers. But as Dr. West has written, it's not all or nothing; there are patients with EGFR mutations despite a significant, recent smoking history: http://cancergrace.org/lung/2007/05/04/tarceva-in-smokers/

So although the chances of finding a mutation may be lower, they do occur. Whether that translates to a willingness to pay for the testing out-of-pocket is a personal choice. Perhaps you can convince your Dad by pointing out how dramatic and long-lasting some patients' responses to Tarceva can be.

JimC
Forum moderator

Yes, exactly as Jim said. However, if someone has a squamous NSCLC, the probability of an EGFR mutation is so low that testing is not the standard of care, as it is for a non-squamous NSCLC. Regardless of the NSCLC subtype, the greater the smoking history (generally measured as the product of average numbers of packs smoked per day x number of years a person smoked = ___ "pack-years"), the lower the probability of an EGFR mutation (or ALK rearrangement).

Good luck.

-Dr. West

Personal anecdote: Have him tested! My father had a significant smoking history and has been
doing well on Tarceva for 10 months now.

Just my personal note: I smoked for about 27 years (not a heavy smoker) and have been a non-smoker for 16 years. My diagnosis was squamous/adenocarcinoma NSCLC. I tested positive for EGFR and have been taking Tarceva 150 for 2 1/2 years. And, thankfully, I'm still stable. My oncologist was surprised I tested positive. Good Luck!!

Great to hear from you, poppyjo, and that you're still doing so well.

You're a great reminder that sometimes people test positive for driver mutation and benefit hugely from targeted therapies despite having a history that doesn't scream a high probability of having a mutation. I suspect that all of us who test patients pretty broadly have had surprising results that remind us why we should continue to cast a wide net.

-Dr. West

Thank you Dr. West. I haven't updated here on GRACE as we moved back to Florida just this last week from Ohio. I have a new oncologist and I am scheduled for a ct scan on the 20th of June. I will update my results after we consult with her. I have 2 friends that have recently been diagnosed with stage 4 cancers and I have given them much hope as I'm still here after 2 1/2 years. poppyjo aka Jane

Hi poppyjo,

Enjoy Florida and good luck on the upcoming scan. We look forward to hearing your great results!

JimC
Forum moderator

My husband's first onc didnt get enough of a sample for testing and dismissed the whole idea anyway. When we changed onc's, the new one wanted to go ahead and do the testing regardless of him being a smoker. That's when we discovered there wasnt enough tissue. As you have know the chances of mutation are much lower in a smoker but it can happen, as per above posts. We never had the chance to know in my husband's case. Best of luck!!!!

Jane, glad you are doing well and I hope your upcoming scan is good!!! Hope your meeting w/new oncologist goes well also! Too funny that you moved from Ohio to Florida. We are here in Ohio while my oldest daughter is living in Florida, enjoy!!!!!