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Case Report

EGFR mutation -- a commonly neglected mutation in squamous cell
lung carcinoma

Rajeev Saini, Ullas Batra, Akhil Jain, Chaturbhuj Agrawal
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110085, India.
Correspondence to: Dr. Rajeev Saini, Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini,
New Delhi 110085, India. E-mail: rajeev.rajeev7@gmail.com

A B S T R AC T
Lung cancer is the leading cause of cancer-related death worldwide. Advances in molecular biology have unveiled various
targetable mutations with epidermal growth factor receptor (EGFR) being most common. EGFR testing is recommended for all
locally advanced or metastatic adenocarcinoma lungs but recommendation in squamous histology is uncertain. However, just
on the basis of histology, EGFR testing should not be withheld in patients diagnosed as squamous cell cancer on small biopsy,
in females, never smokers and Asians. We report two cases with squamous cell lung cancer diagnosed on small biopsy, in non
smoker females with EGFR mutations emphasizing the importance of testing in such population.

Key words: Epidermal growth factor receptor mutation; squamous cell lung carcinoma; never smoker; small biopsy

INTRODUCTION tomography-computed tomography revealed right lung
mass with mediastinal lymph nodes, brain, adrenal,
Lung cancer is the most common cancer in the world pancreatic and bone lesions. A core needle biopsy from
accounting for 12.9% of total cases and 19.4% of total lung mass revealed squamous cell carcinoma, p40 positive
cancer related mortality. Advances in molecular biology and thyroid transcription factor (TTF) negative [Figure 1].
[1]
have led to the identification of mutations within the In view of symptomatic brain metastasis, she was treated
epidermal growth factor receptor (EGFR), and the finding with whole brain radiotherapy followed by two cycles
that these mutations make tumors exquisitely sensitive to of gemcitabine and carboplatin based chemotherapy.
EGFR tyrosine kinase inhibitors (TKIs), has revolutionized However, in view of poor tolerability due to grade 4
treatment of non-small cell lung cancer (NSCLC). EGFR neutropenia and poor performance status, chemotherapy
mutations are more common in never-smokers, in patients could not be given. Her biopsy was reassessed for EGFR
with Asian ethnicity, and in patients with adenocarcinoma mutational analysis and showed L858R mutation positive.
histology. However, solely on the basis of histology, She was started on erlotinib and imaging studies after 2
[2]
EGFR testing should not be excluded in patients with months of therapy demonstrated significant tumor response
squamous cell cancer, especially females, never smokers, in the pulmonary lesions and in the metastatic sites.
Asian ethinicity and squamous histology diagnosed on
small biopsy as adenocarcinomatous component cannot Case 2
be ruled out on small biopsy specimens. We present two A 44-year-old female, diabetic, hypertensive, non smoker
[3]
cases of squamous cell lung cancer diagnosed on small presented with history of breathlessness. Bronchoscopy
biopsy in non smoker females with EGFR mutations who showed malignant intermediate bronchus obstruction.
benefitted with oral TKIs. Bronchial biopsy revealed squamous cell carcinoma
expresses p40 [Figure 2] but negative for TTF1. In view
CASE REPORT of her being non smoker EGFR mutation was tested and
was positive for exon 21L858R mutation. After 3 cycles of
Case 1 gemcitabine and cisplatin based chemotherapy there was
A 56-year-old female, diabetic, hypertensive, non smoker partial response and now she was on maintenance erlotinib
presented with history of cough, weight loss and right sided with good disease control.
weakness. Magnetic resonance imaging brain showed two
hypodense lesions in left frontal lobe. Positron emission This is an open access article distributed under the terms of the Creative
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How to cite this article: Saini R, Batra U, Jain A, Agrawal C. EGFR
mutation -- a commonly neglected mutation in squamous cell lung
DOI: carcinoma. J Cancer Metastasis Treat 2016;2:253-4.
10.20517/2394-4722.2016.07
Received: 03-02-2016; Accepted: 10-05-2016.
©2016 Journal of Cancer Metastasis and Treatment ¦ Published by OAE Publishing Inc. 253