Editors' ChoiceCancer

No lung cancer left behind

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Science Translational Medicine  27 Jan 2016:
Vol. 8, Issue 323, pp. 323ec16
DOI: 10.1126/scitranslmed.aaf0868

Non–small cell lung cancer (NSCLC) is a leading cause of cancer deaths worldwide. In the last decade, patients with advanced NSCLC driven by druggable molecular drivers such as epidermal growth factor receptor (EGFR)–activating mutations and anaplastic lymphoma kinase (ALK) gene rearrangements have seen dramatic improvements in outcomes. Although the benefits of targeted therapies in molecularly selected populations are well established, routine testing in the general NSCLC patient population has proven challenging due to issues of cost, tissue acquisition, and turnaround time, among others.

A study funded by the French National Cancer Institute now shows the feasibility of nationwide molecular profiling of patients with advanced NSCLC. The primary objective of the study was to describe the frequency of molecular alterations in six genes (EGFR, HER2, KRAS, BRAF, and PIK3CA mutations and ALK rearrangements) in consecutive patients with nonsquamous NSCLC evaluated by a nationwide approach over one year. The mandatory molecular screening was initiated by over 3500 clinicians, and testing was conducted at 28 certified molecular genetics centers covering the whole of France. 18,679 molecular analyses were conducted among 17,664 patients. The turnaround time for results was reasonable; the median interval between specimen collection and reporting was approximately 3 weeks. A molecular alteration was identified in approximately 50% of cases and influenced treatment in nearly half of those cases.

This study demonstrates the feasibility of systematic large-scale molecular profiling of lung cancer at the population level. As molecular testing and treatment become increasingly complex, nationwide strategies such as this one will be needed to ensure easy access to molecular testing for all cancer patients.

F. Barlesi et al., Routine molecular profiling of patients with advanced non-small-cell lung cancer: Results of a 1-year nationwide programme of the French Cooperative Thoracic Intergroup (IFCT). Lancet 10.1016/S0140-6736(16)00004-0 (2016). [Full Text]

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