Patients with a smoking history who have lung adenocarcinoma and a targetable alteration have the same likelihood of benefitting from targeted therapy as patients without a smoking history and a targetable alteration, according to recent research published in Clinical Cancer Research (online December 7, 2017; doi:10.1158/1078-0432.CCR-17-2289).
Dara Aisner, PhD, University of Colorado Cancer Center, Lung Cancer Mutation Consortium, and colleagues engaged in a collaboration to investigate the genetic drivers of lung cancer. Over the course of data collection, researchers identified 16 United States institutions that enrolled 1367 patients with lung cancer, of whom 904 patients had genetic testing for at least one of 14 cancer-related genes. The study sought to better understand outcomes of smokers and non-smokers who were treated with targeted therapies against EGFR, ALK, or ROS1.
Researchers reported that the use of targeted therapies in patients with EGFR, ERBB2, BRAF p.V600E mutations, ALK, ROS1 or RET rearrangements, or MET amplification was associated with a survival increment of 1.5 years compared with patients with such mutations not receiving targeted therapy and 1.0 years compared with those not exhibiting a targetable driver. Researchers also noted that 60 patients with a history of smoking derived similar benefit from targeted therapy for alterations in EGFR, ALK or ROS1, compared with 75 patients without a smoking history with the same alterations.
Additionally, Dr Aisner and colleagues noted that co-existing TP53 mutations were associated with shorter survival among patients with EGFR, ALK, or ROS1 alterations.
Results of the study led researchers to conclude that patients with lung adenocarcinoma and an oncogenic driver mutation treated with targeted therapy benefit from longer survival, regardless of prior smoking history. “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,” they wrote.
"Essentially, no matter if you do or do not smoke, if your lung cancer holds a targetable alteration, you have the same chance of benefitting from targeted treatments," Dr Aisner said in an interview (December 13, 2017).—Zachary Bessette