Gene Testing Identifies Lung Cancer Patients Who Benefit From ALK-Inhibitor Drug

Results of a new study in non-small cell lung cancer showed that patients with specific oncogenic rearrangements of the anaplastic lymphoma kinase (ALK) gene within the short arm of chromosome 2 of their tumors had a much greater response to a new therapy – an ALK-inhibitor.

Findings were presented at the AACR-IASLC Joint Conference on Molecular Origins of Lung Cancer, held here from Jan. 11-14, 2010.

D. Ross Camidge, M.D., Ph.D., clinical director of the Thoracic Oncology Program at the University of Colorado, said this study and its results are an example of how all lung cancers are not created equal.

“This helps prove the principle that there may be many different molecularly defined diseases lurking under the same non-small cell lung cancer umbrella, each of which may derive considerable benefit from drugs that are highly specific to these molecular abnormalities if only we knew what they were. Here we have begun to move away from a one-size-fits-all treatment by testing lung cancers for specific genetic changes in advance of choosing the treatment for them,” Camidge said. Read more

Blood Test May Aid In Lung Cancer Diagnosis And Reduce Unnecessary Invasive Procedures

Of the nearly 150,000 abnormal chest X-rays performed each year in the United States, 25 percent of patients will display only benign lung pathologies on further surgical examination.

This false-positive rate has important clinical implications in cost and side effects. A recent report in the Annals of Internal Medicine showed that CT scans, often used as a follow-up to X-rays, were linked to cancer because of their high doses of radiation.

Steven Dubinett, M.D., professor of medicine and pathology, and director of the Lung Cancer Research Program at the Jonsson Comprehensive Cancer Center at the David Geffen School of Medicine, University of California, Los Angeles, said that while findings regarding the detrimental effects of imaging studies like CT scanning are still somewhat controversial, the need for more accurate testing is not.

In a study presented at the AACR-IASLC Joint Conference on Molecular Origins of Lung Cancer, Dubinett and colleagues assembled a 40-marker panel of potential lung cancer biomarkers based on previous investigations from 90 patients with lung cancer as well as 56 control patients thought to be at high risk due to their smoking histories.

“The diagnosis of an indeterminate pulmonary lesion can be difficult, and current methods for confirming an abnormal imaging study include invasive procedures for biopsies,” said Dubinett. “We anticipate that in the future, blood tests will be clinically relevant and lead to reduced use of more invasive diagnostic measures.” Read more

Erlotinib Dosing In Lung Cancer Depends On Smoking Status

Although erlotinib is an approved second-line therapy for lung cancer, its management is complicated by side effects that get worse as the dose increases.

“Increased doses may lead to better outcomes, so we are trying to determine how high we can go with this agent without having to stop,” said Lynsay Waller, M.D., a fellow at Wake Forest University, who presented her data at the AACR-IASLC Joint Conference on Molecular Origins of Lung Cancer, held here Jan. 11-14, 2010.

Waller and colleagues evaluated 25 patients and put them on a chemotherapy regimen that began with docetaxel, cisplatin and pegfilgrastim growth factor support. The researchers then started administering erlotinib at 150 mg daily for non-smokers and 300 mg daily for smokers. These doses were increased every two weeks until development of grade 2 toxicity, when the doses stabilized. If grade 3 toxicity emerged, the doses were cut back by 75 mg a day.

Doses reached as high as 525 mg for smokers and 225 mg for non-smokers, but by the end of the study most smokers had a maximum tolerated dose of 300 mg compared with 225 mg for non-smokers. Read more

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