Pathologists Identify Patterns of Mutations to Help Inform Design of Future Trials
Molecular driven therapeutic targets have resulted in a paradigm shift in the treatment of advanced lung adenocarcinoma. However, in early non–small cell lung cancer (NSCLC), surgical resection remains the treatment of choice with adjuvant chemotherapy. In a recent study published in the April 2013 issue of the International Association for the Study of Lung Cancer’s (IASLC) Journal of Thoracic Oncology, researchers identified patterns of mutations in early-stage, node-negative lung adenocarcinoma.
Study Details
The researchers retrospectively reviewed 204 patients with stage IB primary lung adenocarcinoma who underwent surgical resection between January 1990 and May 2008. Patients who received neoadjuvant or adjuvant treatments were excluded.
The study demonstrates that mutations are common in resected, early, node-negative, treatment-naive lung adenocarcinoma with 54% of patients having tumors that harbor at least one biologically relevant mutation. Although mutations in KRAS, EGFR, and ALK were mutually exclusive, some tumors harbored synchronous mutations within a single oncogene such as double EGFR mutations or within two different oncogenes in the case of comutations.
The researchers unexpectedly found that there were also mutations associated with drug resistance despite the fact that this was a cohort of patients with early-stage disease who had not been treated with chemotherapy or targeted agents.
Compelling Evidence
The researchers concluded that their data provide, “compelling evidence for comprehensive tumor mutation profiling as an essential element of adjuvant trial design, as DNA changes present in advanced cancer cohorts do not necessarily match those from early-stage disease.”
The lead author of this work is IASLC member Po Yee Yip, MBChB, FRACP. Coauthors include IASLC members Wendy A. Cooper, FRCPA, PhD; Catherine W. Kennedy, RMRA; Brian C. McCaughan, MBBS, FRACS; Michael J. Boyer, FRACP, PhD; and Sandra A. O’Toole, FRCPA, PhD.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
