Background: Metastatic lung cancer is the leading cause of cancer-related death in the US. In the last decade, however, patients (pts) with EGFR mutations have benefitted from improved outcomes with EGFR-directed targeted therapy. We hypothesized that this improvement might impact EOL care. The objective of this chart review was to describe the care of EGFR mutant pts with attention to EOL care, health care utilization, and palliative care use. Methods: With IRB approval, we retrospectively reviewed medical records of pts at our center diagnosed with advanced EGFR-mutant lung cancer from January 2009 to June 2012. We limited the review to pts who had at least one cancer therapy at MGH, and to those who died by June 2014. Results: 44 pts were included. 30 pts (68%) were female. 32 pts (73%) received cancer-directed therapy within 30 days of death. Of these, 30 pts (68%) received oral chemotherapy and 5 (11%) received IV chemotherapy. 30 pts (68%) were hospitalized within 30 days of death. Over their entire disease course, the median number of hospitalizations was 2 (0-8), and the median number of total inpatient days was 12 (0-88). 21 pts (48%) had a palliative care outpatient visit and 34 (77%) had an inpatient palliative care consult at some point during their care. 24 pts (54%) enrolled on hospice prior to death, 15 (34%) were never on hospice, and the hospice status of 5 (11%) was unknown. Of the 39 pts with known hospice status, median length of stay was 6 days (0-206). 23 pts (52%) died at home with hospice or in an inpatient hospice, 16 (36%) died in the hospital, 2 (4%) died at home without hospice, and the location of death was unknown for 3 (7%). Conclusions: Pts with EGFR mutations had high rates of hospitalization and chemotherapy use in the last month of life, and many died in the hospital. Palliative care utilization was high, but it is unclear how this affected EOL care. Designing innovative care models to support this unique population and understand EOL decision-making should be a priority.