Neoadjuvant Erlotinib and Surgical Resection of a Stage IIIA Papillary Adenocarcinoma of the Lung with an L861Q Activating EGFR Mutation

The use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIS) is evolving, as is an understanding of predictive biomarkers for tumour response in non-small-cell lung cancer (NSCLC). In this report, we describe a case of rapidly progressing, borderline-resectable, clinical stage IIIA (micro) papillary adenocarcinoma in a 78-year-old woman who experienced a profound response to neoadjuvant erlotinib without short-term toxicity. On EGFR mutation testing, this patient had an uncommon activating point mutation at L861Q in exon 21. Her response permitted successful surgical resection with negative margins and avoidance of chemoradiation, which she was deemed too frail to tolerate. Our case addresses unique management issues such as preoperative testing for EGFR mutation, utility of histology in predicting EGFR mutations, and use of egfr-tkis pre- and postoperatively for potentially resectable NSCLC.