Genotyping and genomic profiling of non-small-cell lung cancer: Implications for current and future therapies

T. Li, H.-J. Kung, P.C. Mack, D.R. Gandara

Research output: Contribution to journalArticle

297 Citations (Scopus)

Abstract

Substantial advances have been made in understanding critical molecular and cellular mechanisms driving tumor initiation, maintenance, and progression in non-small-cell lung cancer (NSCLC). Over the last decade, these findings have led to the discovery of a variety of novel drug targets and the development of new treatment strategies. Already, the standard of care for patients with advanced-stage NSCLC is shifting from selecting therapy empirically based on a patient's clinicopathologic features to using biomarker-driven treatment algorithms based on the molecular profile of a patient's tumor. This approach is currently best exemplified by treating patients with NSCLC with first-line tyrosine kinase inhibitors when their cancers harbor gain-of-function hotspot mutations in the epidermal growth factor receptor (EGFR) gene or anaplastic lymphoma kinase (ALK) gene rearrangements. These genotype-based targeted therapies represent the first step toward personalizing NSCLC therapy. Recent technology advances in multiplex genotyping and high-throughput genomic profiling by next-generation sequencing technologies now offer the possibility of rapidly and comprehensively interrogating the cancer genome of individual patients from small tumor biopsies. This advance provides the basis for categorizing molecular-defined subsets of patients with NSCLC in whom a growing list of novel molecularly targeted therapeutics are clinically evaluable and additional novel drug targets can be discovered. Increasingly, practicing oncologists are facing the challenge of determining how to select, interpret, and apply these new genetic and genomic assays. This review summarizes the evolution, early success, current status, challenges, and opportunities for clinical application of genotyping and genomic tests in therapeutic decision making for NSCLC. © 2013 by American Society of Clinical Oncology.
Original languageEnglish
Pages (from-to)1039-1049
Number of pages11
JournalJournal of Clinical Oncology
Volume31
Issue number8
DOIs
Publication statusPublished - 2013
Externally publishedYes

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Keywords

  • afatinib
  • anaplastic lymphoma kinase
  • crizotinib
  • dacomitinib
  • epidermal growth factor receptor
  • erlotinib
  • gefitinib
  • lapatinib
  • protein tyrosine kinase inhibitor
  • trastuzumab
  • advanced cancer
  • cancer genetics
  • cancer growth
  • drug targeting
  • gain of function mutation
  • gene rearrangement
  • gene sequence
  • genetic association
  • human
  • lung non small cell cancer
  • medical decision making
  • molecular evolution
  • molecularly targeted therapy
  • patient care
  • priority journal
  • review
  • standard
  • Algorithms
  • Carcinoma, Non-Small-Cell Lung
  • DNA Mutational Analysis
  • Gene Expression Profiling
  • Gene Expression Regulation, Neoplastic
  • Genes, Neoplasm
  • Genetic Testing
  • Genome, Human
  • Genotype
  • Humans
  • Individualized Medicine
  • Lung Neoplasms
  • Patient Selection
  • Tumor Markers, Biological

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