Genomic alterations in lung cancer

Question 1

General types of lung cancer

Answer 1

Small cell (SCLC)
Non-small cell (NSCLC)
- adenocarcinoma
- adenocarcinoma in situ
- squamous carcinoma
- large cell
- neuroendocrine/carcinoid

Question 2

Workup for lung cancer

Answer 2

Dx: bronchoscopy/mediastinoscopy, FNA/core biopsy, +/- sputum cytologies

Staging:
Hx and PE
Chest-Xray/CT (Chest + upper abdominal)
blood counts, chemistries
bone scan (if indicated)
CT/MRI (if indicated)
FDG PET

Question 3

Standard Tx for NSCLC

Answer 3

Early: surgery +/- adjuvant chemo
Locally advanced: concurrent chemo + radiation +/- surgery
Advanced/metastatic: palliative chemo/radiation

Question 4

Chemotherapy used in lung cancer

Answer 4

cytotoxic

future: targeted

Question 5

Genomic alterations in NSCLC

Answer 5

EGFR mutations - T790M, cMET resistance, KRAS mutations

EML4-ALK translocations

Question 6

EGFR mutations in NSCLC

Answer 6

respond dramatically to EGFR-TK inhibitors (10-15% of NSCLC)

mutually exclusive to KRAS mutations (~20% NSCLC)

Question 7

Barriers to EGFR testing

Answer 7

expensive
small biopsies
screen failures - inadequate tissue, 15% prevalence

Question 8

Indications for EGFR testing

Answer 8

Routinely tested
Sufficient time and tissue
Clinical suspicion alone is not sufficient
KRAS - does not change management

Question 9

EML4-ALK mutations

Answer 9

drives cancer growth
negative prognostic factor
younger non-smokers with adenocarcinoma
almost mutually exclusive with EGFR mutation
positive predictive for crizotinib
routinely tested

Question 10

Most common type of lung cancer

Answer 10

adenocarcinoma (~50%)