|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 153-154
Molecular tumor boards: Demystifying complex algorithms in non-small cell lung cancer
Ullas Batra, Mansi Sharma, BP Amrith
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
|Date of Submission||05-Jan-2020|
|Date of Acceptance||06-Jan-2020|
|Date of Web Publication||24-Feb-2020|
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Batra U, Sharma M, Amrith B P. Molecular tumor boards: Demystifying complex algorithms in non-small cell lung cancer. Cancer Res Stat Treat 2020;3:153-4
|How to cite this URL:|
Batra U, Sharma M, Amrith B P. Molecular tumor boards: Demystifying complex algorithms in non-small cell lung cancer. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Apr 4];3:153-4. Available from: http://www.crstonline.com/text.asp?2020/3/1/153/279088
We have read with interest the case report published by Kapoor et al. which brings out very clinically relevant and practical points. The response rate to tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) is approximately 76%., While this response rate is very impressive, it also implies that some patients will not respond to the targeted therapies. In addition, the tumor ultimately develops resistance to these TKIs, and the goal of long-term cure is still a dream.
The next-generation sequencing (NGS) is an important tool in the identification of primary and secondary resistance to EGFR-TKIs. Mesenchymal–epithelial transition factor (MET) activation has been implicated as an oncogenic driver in EGFR mutant NSCLC and can mediate primary and secondary resistance to EGFR-TKIs. Various trials are currently underway that are testing the combination of TKIs and MET inhibitors in EGFR mutant NSCLC.
As mentioned above, we believe that although the first-generation EGFR-TKIs have revolutionized treatment of EGFR mutant NSCLC, we need to look beyond first-generation TKIs. The future of treatment of EGFR mutant NSCLC could be third-generation TKIs, combination TKI-chemotherapy, combination TKIs-anti-angiogenic agents, or a TKI-TKI combination (TATTON/SAVANNAH study). As regards to the last choice, NGS could be an effective tool in understanding and planning new TKI-TKI combinations. However, it must be remembered that it is futuristic and at present, TKI-TKI combination should not be tried outside of a clinical trial setting.
On the other hand, immunotherapy has made huge inroads in the management of non molecularly driven NSCLC, and small proportions of patients with Stage IV NSCLC have attained long-term survival. It was postulated that a combination of immunotherapy and EGFR-TKIs may lead to an improved survival in EGFR mutant NSCLC. However, trials have conclusively proven that immunotherapy does not work in oncogene addicted NSCLC and may even be detrimental. Hence, immunotherapy should not be started in the first-line treatment of NSCLC till the results of biomarker testing are available.
Finally, the authors must be congratulated for conducting a molecular tumor board in their institution. As oncologists, we all must be aware of the fact that NSCLC is a heterogeneous disease, and the involvement of various specialties is mandatory in guiding treatment decisions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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. Molecular tumor board: Case 1-Interplay of EGFR, MET and PD-L1 in non-small cell lung carcinoma. Cancer Res Stat Treat 2019;2:228-31. [Full text]
Rajendra A, Noronha V, Joshi A, Patil VM, Menon N, Prabhash K. Epidermal growth factor receptor-mutated non-small-cell lung cancer: A primer on contemporary management. Cancer Res Stat Treat 2019;2:36-53. [Full text]
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