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Requesting an EGFR mutation test

Requesting an EGFR mutation test

Different countries, regions and hospitals vary significantly in how they request an epidermal growth factor receptor (EGFR) mutation test. In some hospitals or centres it is performed automatically once a diagnosis of advanced non-small cell lung cancer (NSCLC) has been made. This is referred to as reflex testing. In other hospitals, a specific request has to be made by the treating physician once appropriate consent has been obtained from the patient.

In some countries, national web-based EGFR mutation test request systems have been established, which facilitate efficient and high-quality EGFR mutation testing. Others use specific request forms that should be completed promptly and in full to avoid any delay in the testing process. At progression on an EGFR tyrosine kinase inhibitor, it must be specified on the form that at an EGFR T790M test is required. It may also be useful at this stage to characterise any driver mutations present at progression (e.g. EGFR exon 19 deletions and L858R), as this can aid with treatment decisions. The request system should specify what is required to perform the EGFR mutation test so that the appropriate sample and information is provided.1

Sample report form

Data reporting and treatment decisions

EGFR mutation data should be reported using the Human Genome Variation Society Recommendations. This ensures that the EGFR mutation test results can be understood and interpreted by the treating physician to allow accurate treatment decisions to be made.

Reporting forms vary among different labs, based on laboratory information system capabilities and institutional needs. The College of American Pathologists (CAP) offers a template that has been reviewed by the CAP Cancer, Molecular Oncology, Immunohistochemistry and Pathology Electronic Reporting Committee then opened to formal public comment and field tested.2 The template incorporates standards based on existing guidelines3,4 and can be accessed directly from the College of American Pathologists website (www.cap.org/cancerprotocols).

A sample lung report is available for download here.

Physicians use EGFR mutation test results to help inform their treatment decisions. Therefore, EGFR mutation test results should be reported clearly and accurately so that the results can be fully understood and easily interpreted.