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Next generation sequencing for detection of EGFR alterations in NSCLC: is more better?
  1. Ullas Batra1,
  2. Shrinidhi Nathany2,
  3. Mansi Sharma1,
  4. Parveen Jain1,
  5. Anurag Mehta3
  1. 1Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
  2. 2Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
  3. 3Laboratory Services, Molecular Diagnostics and Transfusion Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
  1. Correspondence to Dr Ullas Batra, Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi 110085, India; ullasbatra{at}


Aims The emergence of sophisticated next generation sequencing (NGS) based technologies in routine molecular diagnostics has paved the way for robust and accurate detection of variants which may otherwise be missed on single gene testing. This study aims at highlighting the same premise in EGFR mutated non-small cell lung carcinoma (NSCLC).

Methods 1350 cases of NSCLC were screened, of which 490 EGFR mutated cases were taken. The clinical records and molecular features were evaluated retrospectively to determine those cases which were missed on single gene testing.

Results Among these 490 cases, there were 11 (2.2%) cases which tested negative on single gene testing using polymerase chain reaction (therascreen). These were then subjected to NGS based testing and were positive for 13 different EGFR mutations. Five out of the 11 cases received EGFR tyrosine kinase inhibitor (TKI) based on the NGS test outcome. Four cases with exon 20 insertion mutations were not offered TKI as these mutations are known to be intrinsically resistant to TKI therapy. The five patients who have been treated with TKI have shown fair response and have not progressed to date.

Conclusions We demonstrated a potentially preferable way to profile treatment-naïve patients with NSCLC by NGS and from our early experience in EGFR mutant cases, the advantages of NGS over single gene testing is clearly evident.

  • lung
  • lung neoplasms
  • pathology
  • molecular
  • polymerase chain reaction
  • medical oncology

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  • Handling editor Runjan Chetty.

  • Contributors UB was the mentor guide for the project, clinical oncology head and reviewer of the manuscript. SN performed molecular testing and next generation sequencing (NGS) interpretation and wrote the manuscript. MS and PJ were treating oncologists and curated data. AM performed and supervised NGS interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Institutional Review Board of the Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article and will be available from the corresponding author on request.

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