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Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 692-701

Impact of epidermal growth factor receptor T790M testing in relapsed non-small cell lung cancer: A narrative review of the T790M reflex testing algorithm

1 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_169_21

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Reflex testing for the T790M mutation is important in patients with non-small cell lung cancer (NSCLC) who progress on first- or second-generation tyrosine kinase inhibitors (TKIs). Reflex testing, initiated by the treating medical oncologist, allows for the faster identification of patients who are eligible to receive a third-generation TKI such as osimertinib, which is the only TKI to report favorable outcomes in patients with T790M mutation. International guidelines and the Indian consensus guidelines recommend tissue rebiopsy as the gold standard to source genetic material for the testing of molecular biomarkers. As a result of its non-invasiveness, although liquid profiling is currently preferred as a starting point for diagnosing T790M mutations, in the case of inconclusive results, repeat tissue biopsy and reflex tissue-based T790M testing are deemed essential because of higher diagnostic certainty. Medical oncologists along with interventional radiologists and pathologists play a critical role in ensuring the feasibility of repeat tissue biopsy in patients with advanced NSCLC. Reflex tissue testing has the potential to identify acquired T790M mutation in patients with lung cancer at progression. We conducted a literature search in Embase and PubMed for the relevant articles to be included in this review. We also referred to the international and local guidelines to develop the testing algorithm. This narrative review provides a practical algorithm for reflex tissue testing and explains the significance of tissue rebiopsy in improving treatment outcomes in patients with NSCLC post-disease progression.

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