Abstract
Reality check for precision oncology in squamous cell lung cancer.
Author
person
Maham Bakhtyar
UAMS-Winthrop Rockefeller Cancer Institute, Little Rock, AR
info_outline
Maham Bakhtyar, Sajjad Akbar Bhatti
Full text
Authors
person
Maham Bakhtyar
UAMS-Winthrop Rockefeller Cancer Institute, Little Rock, AR
info_outline
Maham Bakhtyar, Sajjad Akbar Bhatti
Organizations
UAMS-Winthrop Rockefeller Cancer Institute, Little Rock, AR, UAMS Medical College Physicians Group, Little Rock, AR
Abstract Disclosures
Research Funding
No funding received
None.
Background:
Squamous cell lung cancer (SqCLC) is the second most common type of pulmonary malignancy after lung adenocarcinoma. Therapeutic advances in Precision Oncology have significantly improved outcomes in subsets of patients with lung adenocarcinoma. However, a significantly different mutational landscape has limited the success of Precision Oncology in SqCLC. Still, NCCN guidelines recommend considering molecular testing in SqCLC, preferably with broad-based molecular profiling like next-generation sequencing (NGS), aiming to identify candidates for FDA-approved targeted therapy. We aim to evaluate the percentage of SqCLC potentially eligible for targeted therapy using NGS by analyzing data from The Cancer Genome Atlas (TCGA).
Methods:
We filtered cases with a SqCLC diagnosis from the TCGA database. These cases were screened for DNA/RNA alterations in the 9 NCCN-guidelines recommended genes, including EGFR/ALK/ROS1/BRAF/MET/RET/HER2/NTRK/KRAS. Each unique alteration in the genes mentioned above was then analyzed in the oncoKB database to predict clinical benefit with level 1 and 2A evidence from FDA-approved targeted therapy. We then calculated the percentage of patients with SqCLC tested with NGS who could assess approved matched targeted therapy.
Results:
We identified 501 unique cases of SqCLC diagnosis in the TCGA. In the 9 NCCN-recommended actionable genes, 206 alterations were detected. We reviewed the clinical implication and utility of each of these alterations in the OncoKB database, and only 5 alterations were consistent with level 1/2A clinical benefit from a matched targeted therapy. These included 2 cases with L861Q and one each with EGFR L858R, EGFR E746_A750 exon 19 deletion, and G222C missense in the ERBB2 gene.
Conclusions:
The percentage of squamous cell cases which are potential candidates for FDA-approved targeted therapy was relatively low, 0.1% (5/501). While next-generation sequencing will not affect the standard of care treatment options for most SqCLC patients, clinicians can use this information to counsel patients for enrollment in clinical trials.
Actionable gene mutations in squamous cell lung cancer.
No.
Genes Identified
Total No. of Mutations
No. of Actionable Mutations
Actionable Mutations
1
EGFR
15
4
L861Q (2)
L858R
E746_A750del
2
ALK
20
3
ROS1
48
4
NTRK1
21
5
NTRK2
0
6
NTRK3
38
7
MET
9
8
RET
22
9
ERBB2
9
1
G222C
10
KRAS
9
11
BRAF
15
Total
206
5
2 organizations
1 product
8 drugs
11 targets
Organization
UAMS-Winthrop Rockefeller Cancer InstituteOrganization
UAMS Medical College Physicians GroupDrug
MelphalanDrug
ROS1 TKIsDrug
BRAFProduct
TMZDrug
RET TKIsDrug
HER2 CAR-TDrug
NTRKiDrug
KRASTarget
ROS1Target
KRAS G12CTarget
BRAFTarget
ALKTarget
RETTarget
HER2 (ERBB2)Target
metastatic breast cancerTarget
NTRK1Target
NTRK2Target
NTRK3