Genomics Case 1 Question 2A by https://padlet.com/haspelr/mn1tp7tdubz7vs5a The patient is found to have an EGFR exon 19 deletion and is started on treatment with erlotinib. Initial scans indicate treatment response. After 16 months, however, the patient develops new symptoms and a CT scan shows progression of the disease with a new liver lesion. Molecular testing shows a new EGFR variant T790M, which confers resistance to the initially prescribed tyrosine kinase inhibitor. The patient is started on osimertinib and has stable disease until a year later, when a CT scan shows significant enlargement of the initial liver lesion and new metastatic liver foci. en-us 2021-09-16 14:52:14 UTC 2021-10-28 12:31:15 UTC hello@padlet.com Sampling Options haspelr https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1746224294 Options for sampling include a liver metastasis and a liquid biopsy. Which would you select for subsequent molecular testing, and what are the advantages and disadvantages of each? 
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]]> 2021-09-16 14:52:14 UTC https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1746224294 https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767701783 Get liver bx; liquid bx only if tissue is not available]]> 2021-09-25 19:21:14 UTC https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767701783 https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767701878 Liver metastasis ]]> 2021-09-25 19:21:20 UTC https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767701878 Start with liquid bx. If pos then stop. https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702210 2021-09-25 19:21:46 UTC https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702210 https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702296 liver biopsy is first choice. if unavailable, then liquid biopsy]]> 2021-09-25 19:21:52 UTC https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702296 https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702429 Liquid biopsy because of the ability to measure heterogeneity and less invasive to patient. If no driver alterations detected with liquid, test liver met.]]> 2021-09-25 19:22:02 UTC https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702429 https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702533 Liver box because it will show new mutations or resistant ones]]> 2021-09-25 19:22:09 UTC https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702533 https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702877 CtDNA. Liver bx has 2x nuclei in normal which requires high tumor cellularity for success. Edge alterations easily identified in liquid.]]> 2021-09-25 19:22:35 UTC https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767702877 Sampling the liver met. Honestly, because of familiarity, and lack of experience with liquid biopsy https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767703298 2021-09-25 19:23:05 UTC https://padlet.com/haspelr/mn1tp7tdubz7vs5a/wish/1767703298