ALTER – (eArLy sTage EgFR Testing)

STUDY CLOSED MARCH 31, 2023 – Publicly funded Focus Panel NGS testing is now available for early stage lung cancer and can be ordered using the Molecular Solid Tumour Requisition

This program, sponsored by AstraZeneca, will allow all completely resected (R0) stage IB to stage IIIA NSCLC patients to be tested for mutations in the epidermal growth factor receptor (EGFR) gene. Pathologists and other qualified care providers may order this test reflexively on stage IB to stage IIIA resected specimens. Test results are expected to be available in 10 days or less post specimen receipt, barring exceptional circumstances.

Patients identified with either exon 19 deletions or exon 21 (L858R) substitutions may be eligible for TAGRISSO (osimertinib), as per the recent notice of compliance (NOC) by Health Canada for EGFR mutation-positive NSCLC in the adjuvant setting2, based on the evidence of the ADAURA clinical trial3. Note that changes other than EGFR L858R and exon 19 deletion might contribute to increased or decreased sensitivity to EGFR inhibition and should be interpreted accordingly. Patients with these less common alterations are not eligible for osimertinib in the context of ALTER but the information will be also valuable for treatment planning.

How will EGFR variants be detected in project ALTER?
Testing for EGFR variants will be performed using the Idylla™ EGFR test on FFPE tissue which has been specifically designed to detect the most common variants in EGFR at the stated limit of detection (LOD) including:
• G719A/C/S (LOD = 10%)
• Various exon 19 deletions (LOD = 5%)
• L858R (LOD = 5%)
• T790M (LOD = 5%)
• Various exon 20 insertions/duplications (LOD = 5%)
• L861Q (LOD = 5%)
• S768I (LOD = 5%)


  • Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010 Jun;17(6):1471-4. doi: 10.1245/s10434-010-0985-4. PMID: 20180029.
  • Health Canada Tagrisso Product Monograph:
  • Wu Y, Tsuboi M. He J. et al. Osimertinib in Resected EGFR-Mutated Non-Small-Cell Lung Cancer. N Engl J Med 2020; 383:1711-1723 DOI: 10.1056/NEJMoa2027071