New research confirms need for lung cancer testing

February 2, 2012

Different kinds of lung cancer behave in different ways, suggesting they are fundamentally different diseases. According to a University of Colorado Cancer Center study published in Cancer, the official journal of the American Cancer Society, different subgroups of non-small cell lung cancer (NSCLC) show distinct patterns of spread in the body.

The study looked at 209 patients diagnosed with stage IV separated into four different molecular subgroups using testing performed by the University of Colorado Molecular Correlates Laboratory (CMOCO): those with epidermal growth factor receptor (EGFR) mutations, v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations, anaplastic lymphoma receptor tyrosine kinase (ALK) gene rearrangements or a group without any of these abnormalities.

ALK positive lung cancer was strongly associated with cancers that spread to the linings around the heart and lungs (pericardial and pleural disease). Patients with ALK positive NSCLC were also predisposed to develop as were those with an EGFR mutation when the different subgroups were compared.

"In the last few years we have been able to separate lung cancer into different molecular subtypes to help improve outcomes from specific targeted therapies. This study really confirms that these molecular subtypes are manifesting as different diseases in patients," said Robert Doebele, MD, PhD, lead author of the study and CU Cancer Center investigator.

Another University of Colorado study published in the same edition of Cancer drills down on how some of these different molecular subtypes of lung cancer are detected in the first place. Specifically, the study examined the companion diagnostic test for detecting the ALK positive lung cancer cases, called a fluorescence in situ hybridization (FISH) test. This test is used to select patients for treatment with crizotinib, an ALK inhibitor drug. Now University of Colorado researchers have solved an unanswered question as to why patients who respond to crizotinib only appear to have the ALK change in a fraction of the cells in their cancers.

By looking in detail at the genetic changes present in the cancer cells they came to two major conclusions. First- cell counts below 100 percent in ALK positive tumors reflect the fact the assay misses a proportion of cells and not that the cells are truly missing the ALK change.

Second, the ALK change happens early in the development of the cancer and is likely to be a fundamental driver of the cancer's growth. The study was conducted by D. Ross Camidge, MD, PhD, the director of the lung cancer clinical program at the CU Cancer Center and University of Colorado Hospital and Marileila Varella Garcia, PhD, professor of medicine, medical oncology and pathology at University of Colorado School of Medicine.

"Knowing that ALK changes are driving the cancer and that they are not actually missing from a significant proportion of the cancer reinforces our understanding of ALK positive lung cancer. It now makes sense why targeting these changes is going to affect a very large proportion of the tumor and explains the dramatic clinical responses seen with crizotinib."

"In order to treat any disease successfully, you have to know what you are really treating," said Camidge." "It is only by understanding better that we can hope to improve outcomes in the long term."

Explore further: Study examines drug resistance in ALK positive lung cancer

Related Stories

Study examines drug resistance in ALK positive lung cancer

January 19, 2012
Scientists from the University of Colorado Cancer Center have once again advanced the treatment of a specific kind of lung cancer. The team has documented how anaplastic lymphoma kinase (ALK) positive advanced non-small cell ...

First and only therapeutic drug for ALK-positive lung cancer approved

August 31, 2011
In a major triumph for personalized medicine, the FDA approved the drug crizotinib for use with the lung cancer type known as ALK-positive.

Benefit of targeted lung cancer therapy confirmed

June 3, 2011
A drug that targets a specific type of lung cancer shows a dramatic response in more than half of the people who take it. The drug, called crizotinib, has been in clinical trials since 2006, and the results from the largest ...

ALK rearrangement found in nearly 10 percent of patients in Lung Cancer Mutation Consortium

July 5, 2011
ALK rearrangement has been found in 9.6% of lung cancer patients tested in the Lung Cancer Mutation Consortium, and MET amplification in another 4.1%, reflecting how many patients might benefit from targeted therapies such ...

Study: Inexpensive method detects ALK rearrangement in lung cancer patients

August 2, 2011
A relatively simple and inexpensive method may be used to determine whether a lung cancer patient is a candidate for crizotinib therapy, according to research published in the August issue of the Journal of Thoracic Oncology, ...

Lung cancer ALK rearrangement may predict pemetrexed efficacy, study shows

September 1, 2011
Patients with ALK-rearranged non-small cell lung cancer (NSCLC) responded significantly better to pemetrexed (brand name: Alimta) than patients whose cancer did not show ALK translocation, according to research published ...

Recommended for you

CAR-T immunotherapy may help blood cancer patients who don't respond to standard treatments

October 20, 2017
Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis is one of the first centers nationwide to offer a new immunotherapy that targets certain blood cancers. Newly approved ...

Researchers pinpoint causes for spike in breast cancer genetic testing

October 20, 2017
A sharp rise in the number of women seeking BRCA genetic testing to evaluate their risk of developing breast cancer was driven by multiple factors, including celebrity endorsement, according to researchers at the University ...

Study shows how nerves drive prostate cancer

October 19, 2017
In a study in today's issue of Science, researchers at Albert Einstein College of Medicine, part of Montefiore Medicine, report that certain nerves sustain prostate cancer growth by triggering a switch that causes tumor vessels ...

Gene circuit switches on inside cancer cells, triggers immune attack

October 19, 2017
Researchers at MIT have developed a synthetic gene circuit that triggers the body's immune system to attack cancers when it detects signs of the disease.

One to 10 mutations are needed to drive cancer, scientists find

October 19, 2017
For the first time, scientists have provided unbiased estimates of the number of mutations needed for cancers to develop, in a study of more than 7,500 tumours across 29 cancer types. Researchers from the Wellcome Trust Sanger ...

New study reveals breast cancer cells recycle their own ammonia waste as fuel

October 19, 2017
Breast cancer cells recycle ammonia, a waste byproduct of cell metabolism, and use it as a source of nitrogen to fuel tumor growth, report scientists from Harvard Medical School in the journal Science.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.