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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 156

A commentary on molecular tumor board: Case 1-interplay of epidermal growth factor receptor, MET, and programmed death-ligand 1 in non-small cell lung carcinoma


Institute of Bioinformatics, International Technology Park, Bangalore; Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India

Date of Submission31-Dec-2019
Date of Acceptance08-Jan-2020
Date of Web Publication24-Feb-2020

Correspondence Address:
Prashant Kumar
Faculty Scientist, Institute of Bioinformatics, Discoverer Building, International Technology Park, Whitefield, Bengaluru - 560 066, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_134_19

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How to cite this article:
Deb B, Kumar P. A commentary on molecular tumor board: Case 1-interplay of epidermal growth factor receptor, MET, and programmed death-ligand 1 in non-small cell lung carcinoma. Cancer Res Stat Treat 2020;3:156

How to cite this URL:
Deb B, Kumar P. A commentary on molecular tumor board: Case 1-interplay of epidermal growth factor receptor, MET, and programmed death-ligand 1 in non-small cell lung carcinoma. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Mar 30];3:156. Available from: http://www.crstonline.com/text.asp?2020/3/1/156/279093



Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have significantly improved clinical outcomes as compared to chemotherapy in non-small cell lung carcinoma (NSCLC) patients with sensitizing EGFR gene mutations.[1] In these patients, the treatment of choice as first-line therapy is first- or second-generation EGFR-TKIs. In the study by Kapoor et al.,[2] the authors have discussed the interplay of EGFR, MET, and PD-L1 in NSCLC by describing the case of a 62-year-old woman who was diagnosed with poorly differentiated adenocarcinoma. They addressed a unique case where the patient was positive for EGFR exon 19 deletion and tumor proportion score (TPS) for programmed death-ligand 1 (PD-L1) was 85%–90% positive. The patient harbored a classical EGFR activating mutation and EGFR-directed therapy, afatinib was recommended. However, since a MET inhibitor has not been approved in combination with an EGFR TKI, regardless of multiple mutations, the authors have stated that the treatment decision in the first line was based on the gold standard PCR testing for EGFR. The authors explain appropriately that if the combination of EGFR and MET therapy is approved in this setting, the treatment choice will also evolve. Furthermore, the authors also explain that it is prudent to wait for the EGFR and anaplastic lymphoma kinase clinical reports before starting immunotherapy in patients with advanced lung cancer.

This study illustrates the complexity of a genomic profile of NSCLC and provides a strong support for the next-generation sequencing (NGS) as a preferred method for routine clinical testing. However, this article lacks the clarity on the conclusive treatment regimen and the treatment outcome of the case presented. A very interesting aspect of the study is that the NGS revealed AR positivity in the patient. Recent studies have reported that AR-positive patients appear to have aggressive clinical courses. Hence, these patients must be closely examined for treatment selection and better prognosis.[3] In addition, schematic representation of the longitudinal treatment protocol, immunohistochemistry showing the poorly differentiated adenocarcinoma cells and images of PD-L1 positivity TPS would present the study comprehensively and stimulate readers to follow the field.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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.  Back to cited text no. 1
  [Full text]  
2.
Kapoor A, Noronha V, Chougule A, Patil V, Menon N, Joshi A, et al. 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.  Back to cited text no. 2
  [Full text]  
3.
Berardi R, Morgese F, Santinelli A, Onofri A, Biscotti T, Brunelli A, et al. Hormonal receptors in lung adenocarcinoma: Expression and difference in outcome by sex. Oncotarget 2016;7:82648-57.  Back to cited text no. 3
    




 

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