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Printer Friendly Version Epidermal Growth Factor Receptor for Patients with Non-Small Cell Lung Cancer (NSCLC)
DESCRIPTIONEpidermal growth factor receptor (EGFR) is a receptor tyrosine kinase (TK) frequently overexpressed and activated in non-small cell lung cancer (NSCLC). Mutations in two regions of the EGFR gene (exons 18-24) --small deletions in exon 19 and a point mutation in exon 21 (L858R) -- appear to predict tumor response to tyrosine kinase inhibitors (TKIs) such as erlotinib. This policy summarizes the evidence for using EGFR mutations to decide which patients with advanced NSCLC should be considered for erlotinib therapy and which are better suited for alternative therapies.
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POLICYExcept as noted below, analysis of two types of somatic mutation within the EGFR gene – small deletions in exon 19 and a point mutation in exon 21 (L858R) – may be considered medically necessary to predict treatment response to erlotinib in patients with advanced NSCLC.Analysis of two types of somatic mutation within the EGFR gene – small deletions in exon 19 and a point mutation in exon 21 (L858R) is considered investigational for patients with advanced NSCLC of squamous cell-type. Analysis for other mutations within exons 18-24, or other applications related to NSCLC, is considered investigational.
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POLICY EXCEPTIONSNone
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POLICY GUIDELINESThe coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
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POLICY HISTORY7/27/2006: Approved by Medical Policy Advisory Committee (MPAC)8/16/2007: Policy reviewed, no changes 1/06/09: Policy reviewed. No changes. 04/25/2011: Policy description updated. Policy statement revised to state that analysis of two types of somatic mutation within the EGFR gene – small deletions in exon 19 and a point mutation in exon 21 (L858R) – may be considered medically necessary to predict treatment response to erlotinib in patients with advanced NSCLC. Other applications related to NSCLC remain investigational. Code Reference section changed from non-covered to covered. 02/24/2012: Policy reviewed; no changes. 01/10/2013: Added the following new 2013 CPT code to the Code Reference section: 81235. Added ICD-9 codes 162.3 - 162.9 to the Code Reference section.
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SOURCE(S)Blue Cross Blue Shield Association Policy # 2.04.45
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CODE REFERENCEThis is not intended to be a comprehensive list of codes. Some covered procedure codes have multiple descriptions.The code(s) listed below are ONLY covered if the procedure is performed according to the "Policy" section of this document. Covered Codes
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