Recent advances in the molecular testing for treatment selection in lung cancer
International Conference on Pathology and Surgical Pathology
September 06-07, 2018 | Edinburgh, Scotland
Mulazim Hussain Bukhari
University of Lahore, Pakistan
Posters & Accepted Abstracts : J Pathol Dis Biol
Lung cancer is still a biggest dilemma in developing countries where is no rules and regulations of smoking and control of other palliative agents. Biomakers have recently become a part of standard-of-care treatment for cell lung cancer with the recent FDA approval of different drugs in the second-line setting for patients with advanced disease. The concept of chemotherapy and radiation is rapidly changing in advanced countries due the invention of biomarkers. Lung cancer is a leading cause of malignancy associated human deaths, which is evident from its high mortality rate of 1.6 million (19.4% of total) cancer deaths Worldwide. It is more common in male and elderly group risk factors include smoking, pollution, certain metals (chromium, cadmium), some organic chemicals and radiation. The risk of genetic susceptibility can contribute especially in young. Thyroid transcription factor 1 (TTF1) is expressed by both neuroendocrine and non-neuroendocrine carcinomas of lung but the frequency of expression varies markedly among various histologic types. Sensitivity is highest among adenocarcinomas & non-mucinous bronchoalveolar carcinomas where it is over 90%. Lowest expression is seen in mucinous adenocarcinomas and Squamous cell carcinomas. TTF1 expression is also seen albeit focal in a subset of ovarian & colorectal carcinomas. Striking differences in sensitivity are seen among neuroendocrine tumors of lung, varying from 90% in Small cell carcinoma, 50% in large cell neuroendocrine carcinoma and < 50% in carcinoid tumors. Napsin A is a very sensitive marker for detecting pulmonary adenocarcinomas with a level of sensitivity from 80% to over 90%. The specificity of coexpression of TTF1 and Napsin A is extremely high for pulmonary adenocarcinomas. However Napsin A can be identified in a subset of RCC (most frequently Papillary, up to 80%). Also in a minority of endometrial adenocarcinomas and PTC & Clear cell carcinoma of ovary. EGFR are the most frequent mutations in Pakistani lung adenocarcinoma patients and around 29% of the patients were found eligible for erlotinib therapy. Several other immunotherapeutics are currently under investigation for the treatment of NSCLC, including those that inhibit PD-1 and PD-L1 Conclusion: This is an extremely exciting time in the field of thoracic oncology due to the development of immunotherapeutic drugs targeting to different biomarkers responsible for mutation and in the development of lung cancer. Key areas of ongoing investigation are elucidating a predictive biomarker, determining the most appropriate line of therapy to use these drugs, and defining whether combination with other agents (including chemotherapy, targeted therapy, or other immunotherapies) can provide additional benefit.