The Impact of Smoking and TP53 Mutations in Lung Adenocarcinoma Patients with Targetable Mutations-The Lung Cancer Mutation Consortium (LCMC2).

Abstract

Purpose: Multiplex genomic profiling is standard of care for patients with advanced lung adenocarcinomas. The Lung Cancer Mutation Consortium (LCMC) is a multi-institutional effort to identify and treat oncogenic driver events in patients with lung adenocarcinomas.Experimental Design: Sixteen U.S. institutions enrolled 1,367 patients with lung cancer in LCMC2; 904 were deemed eligible and had at least one of 14 cancer-related genes profiled using validated methods including genotyping, massively parallel sequencing, and IHC.Results: The use of targeted therapies in patients with EGFR, ERBB2, or BRAF p.V600E mutations, ALK, ROS1, or RET rearrangements, or MET amplification was associated with a survival increment of 1.5 years compared with those with such mutations not receiving targeted therapy, and 1.0 year compared with those lacking a targetable driver. Importantly, 60 patients with a history of smoking derived similar survival benefit from targeted therapy for alterations in EGFR/ALK/ROS1, when compared with 75 never smokers with the same alterations. In addition, coexisting TP53 mutations were associated with shorter survival among patients with EGFR, ALK, or ROS1 alterations.Conclusion: Patients with adenocarcinoma of the lung and an oncogenic driver mutation treated with effective targeted therapy have a longer survival, regardless of prior smoking history. Molecular testing should be performed on all individuals with lung adenocarcinomas irrespective of clinical characteristics. Routine use of massively parallel sequencing enables detection of both targetable driver alterations and tumor suppressor gene and other alterations that have potential significance for therapy selection and as predictive markers for the efficacy of treatment. Clin Cancer Res; 24(5); 1038-47. ©2017 AACR.

• Authors: Dara L Aisner, Lynette M Sholl, Lynne D Berry, Michael R Rossi, Heidi Chen, Junya Fujimoto, Andre L Moreira, Suresh S Ramalingam, Liza C Villaruz, Gregory A Otterson, Eric Haura, Katerina Politi, Bonnie Glisson, Jeremy Cetnar, Edward B Garon, Joan Schiller, Saiama N Waqar, Lecia V Sequist, Julie Brahmer, Yu Shyr, Kelly Kugler, Ignacio I Wistuba, Bruce E Johnson, John D Minna, Mark G Kris, Paul A Bunn, David J Kwiatkowski, LCMC2 investigators
• Journal: Clinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 24 Issue 5 Pg. 1038-1047 (03 01 2018) ISSN: 1557-3265 [Electronic] United States
• PMID: 29217530 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: ©2017 American Association for Cancer Research.

Chemical References

• Antineoplastic Agents
• Biomarkers, Tumor
• TP53 protein, human
• Tumor Suppressor Protein p53

Topics

• Adenocarcinoma of Lung (drug therapy, etiology, mortality)
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (pharmacology, therapeutic use)
• Biomarkers, Tumor (antagonists & inhibitors, genetics)
• Carcinogenesis (genetics)
• DNA Mutational Analysis
• Female
• High-Throughput Nucleotide Sequencing
• Humans
• Lung Neoplasms (drug therapy, genetics, mortality)
• Male
• Middle Aged
• Molecular Targeted Therapy (methods)
• Mutation
• Prognosis
• Prospective Studies
• Smoking (adverse effects, epidemiology)
• Survival Analysis
• Treatment Outcome
• Tumor Suppressor Protein p53 (genetics)
• Young Adult