Resistance to EGFR inhibitors like gefitinib often comes from the T790M mutation, which is like a stronger lock on the gate the medicine tries to open. Later, the C797S mutation can appear, making even the newer keys useless. In my clinic, however, I see many who never get these fancy tests—we assume resistance when the cough returns and the shadow grows on the old X-ray machine. My real worry is the father who sells his rickshaw for a targeted therapy, only to have it fail in six months; the mutation report from the city lab arrives long after we have seen it in his eyes.
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