ABSTRACT
Ashish JoshiBackground The molecular characterization of advanced non-small-cell lung cancer (NSCLC) has unveiled genomic alterations such as EGFR gene mutations, KRAS gene mutations, ROS1 gene rearrangements, EML4-ALK rearrangements, and altered MET signaling. The objective of this molecular epidemiological study was to report the clinical, pathological, and molecular profile of NSCLC patients from western India. Materials and Methods This real-world study of NSCLC patients was performed at a chemotherapy day-care center in western India. The clinical, pathological, and molecular data were collected from the patient's medical records after obtaining the Ethics Committee permission for the study. The study was conducted according to the ethical principles stated in the latest version of Helsinki Declaration, and the applicable guidelines for good clinical practice. Results A total of 182 (58.7%) men and 128 (41.3%) women with a median age of 63 years (range: 22-93 years) were included in the study. Of the total 310 patients, 195 (62.9%) were nonsmokers whereas 81 (26.1%) had a past history of smoking. EGFR , EML4-ALK Fusion Gene, KRAS , ROS1 gene rearrangement, and PD-L1 were positive in 42 (22.3%), 12 (9%), 2 (28.6%), 3 (12.5%), and 3 (25%) patients, respectively. One patient had concurrent EGFR mutation along with ROS1 gene rearrangement. Conclusion Oncogenic driver mutations are present in Indian NSCLC patients. Molecular testing should be performed for all patients of advanced NSCLC to identify those that can benefit from newer generation of targeted or immunotherapies.
ABSTRACT
AIM: The aim of this study is to determine the incidence of T790M mutations after progression on epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) and median duration on TKI before progression on TKI. METHODS: Records of Rajiv Gandhi Cancer Institute and Research Centre, of patients who were diagnosed with metastatic adenocarcinoma of the lung and progressed on oral EGFR TKIs and underwent T790M mutation analysis in the last 6 months were retrospectively reviewed. The incidence of T790M positivity, sites of progression, and median duration of TKI treatment before progression was calculated. RESULTS: Among 31 patients, 10 patients have undergone rebiopsy, and 24 patients had undergone liquid biopsy by Droplet Digital polymerase chain reaction (ddPCR), and three patients had undergone both tests. Among all, the rate of T790M positivity was 54.8%. Among these 17 patients positive for T790M, seven patients were positive by biopsy, and 11 patients were positive by ddPCR. Among three patients who underwent both, one was positive by both. The most common site of progression among all patients is pleura, and 10% of patients progressed in brain post-TKI. Median progression-free survival on TKI before progression is 289.7 days, highest being 1290 days, and lowest 45 days. CONCLUSIONS: Exact incidence of T790M mutations after progression on TKI s in Asian population is not exactly known and requires large data, as incidence may be different than reported in the Western population. Rebiopsy and ddPCR help to determine the most common type of resistance after progression on TKI, for which effective targeted therapy is available.
