Article and Video CATEGORIES

Cancer Journey

Search By

Differences Among Specific EGFR Mutations
GRACE Videos and Articles
GRACE Cancer Video Library - Lung



Medical oncologist Dr. Greg Riely, MSKCC, discusses evidence for whether there are clinically significant differences among specific EGFR mutations that should lead to differences in management.

Download Transcript

[ratingwidget post_id=0]

Please feel free to offer comments and raise questions in our Discussion Forums.



Within the overview of EGFR mutations, there's several different types — the two most common are EGFR exon 19 deletion and EGFR L858r; together, these represent more than 80% of EGFR mutations. In addition to these two common types, there are some uncommon types, but some of these are related to responsiveness to EGFR tyrosine-kinase inhibitors, so rarer ones like G719A, L861, these are rare, but we have pretty good evidence that they lead to response to drugs, just as those patients who have L858r or exon 19 deletion.

There are patients who have exon 20 insertions — in general, EGFR exon 20 insertions are associated with resistance to EGFR tyrosine-kinase inhibitors like erlotinib, gefitinib and afatinib, and so, as a consequence, that’s not our first line therapy for those patients with EGFR exon 20 insertions.

Going back to the two most common EGFR mutations, exon 19 deletion and EGFR L858r, since these are the most common ones, we have more data on patient outcomes for these two mutations. When we look at a broad variety of data, typically with afatinib, we see that afatinib may actually be more effective for those patients with EGFR exon 19 deletions than it is for patients with EGFR L858r.

There has been similar data reported for patients treated with gefitinib and erlotinib as well. Though the data is not quite as clear cut, it does seem that those drugs also work a bit better for patients with EGFR exon 19 deletions.

Now what the consequence of those differences is, is quite controversial. I think that, in general, I still recommend treatment with an EGFR tyrosine-kinase inhibitor — and I don’t prefer one or the other, for patients with EGFR exon 19 deletions, EGFR L858r, as well as the rarer ones like G719A or L861Q.

Next Previous link

Previous PostNext Post

Related Content

Blood Cancer OncTalk
In this series of videos, Dr. Aaron Goodman chairs the discussion along with speakers Drs. Tycel Phillips, Sridevi Rajeeve, Marco Ruiz and Alankrita Taneja.  Topics include:
View the full Targeted Therapies in Lung Cancer Patient forum from 2023 in YouTube and embedded here! 

Forum Discussions

Hi Blaze,


As much as I hate to say it, Welcome back Blaze.  It sounds like you're otherwise feeling good and enjoying life which is a wonderful place to be. ...

Waiting for my appointment with oncologist this morning. Thank you for the response. It helps. <3

It sounds like you’re thinking of this in a very appropriate way. Specifically, it sounds like the growth of the nodule is rather modest, though keep in mind that the change...

Hi and welcome to GRACE.  I'm sorry your mom is having this difficulty.  An indwelling catheter is used when the pleura space continually fills and the catheter is always there to...

Hi Oaktowngrrl,  Welcome to Grace.  I'm so sorry you're going through this.


 Finding a reputable dedicated thoracic surgeon for lung surgery might be difficult, as it is a complex and...

Recent Comments

Could you
By Maeve785 on
It sounds like you’re…
By Dr West on
Thank you Janine
By blaze100 on
Hi Blaze,


As much as I…
By JanineT GRACE … on