Next generation sequencing for detection of EGFR alterations in NSCLC: is more better?

RT-PCR Misdiagnosis of Patient with Rare EGFR Mutation Lung Adenocarcinoma: Is NGS the Only Solution?

Background and Clinical Significance: Molecular testing plays a crucial role in lung cancer diagnosis and management. While single-gene tests (SGTs) remain an important diagnostic tool, developments in novel methods such as next generation sequencing (NGS) provide a more precise mutational profile and enable the targeted treatment of a larger scope of mutation-driven cancers. Case presentation: We present a case of a patient with a rare EGFR variant lung adenocarcinoma, who was misdiagnosed using a SGT. The initial treatment with immunotherapy was unsuccessful. Conclusions: The patient could have benefited if NGS had been performed instead of traditional real-time polymerase chain reaction (RT-PCR) and if adequate tyrosine kinase inhibitor treatment was initiated at the time of diagnosis.

RNA-Based Next-Generation Sequencing Approach to Non-Small Cell Lung Cancer: A Single-Center Experience in Turkey

INTRODUCTION

Lung cancer is a global health concern. Molecular analysis of tumor tissues, especially in non-small cell lung cancers, has become an integral part of a holistic approach to the management of the disease. Here, molecular genetic data obtained from tumor tissues collected from 373 male and 89 female patients referred to our clinic with a diagnosis of non-small cell lung cancer are presented.

METHODS

Patient samples (n = 462) were assessed via next-generation sequencing using an RNA-based kit containing 36 genes. Data obtained were analyzed using relevant software, and results of analysis are presented together with the demographic characteristics of the patients.

RESULTS

Significant somatic variations were detected in 208 of 462 patients. KRAS and EGFR had the greatest variations. Rearrangements, mostly involving ALK, were observed in 37 patients, and rare complex changes involving different genes were detected in 10 patients.

CONCLUSION

This study presents the comprehensive molecular data obtained using an RNA-based kit that provided information on single-nucleotide variation/insertion-deletion variants (InDel) and rearrangements in a large-patient series from a single center. Somatic variants were detected in approximately 45% of all patients. According to the Catalogue Of Somatic Mutations In Cancer (COSMIC) database, our rate of variants detected in KRAS and FGFR3 genes was higher. The rate of variants detected in other genes was lower. In addition, fusions not reported in COSMIC were detected. With the development of next-generation sequencing-based tests and an increase in their use, a broad perspective has been provided to many disease groups, including solid tissue cancers, especially non-small cell lung cancers.

KRAS mutated Non-Small Lung Carcinoma: A Real World Context from the Indian subcontinent

BACKGROUND

KRAS, although a common variant of occurrence (~20% of non-small-cell lung carcinoma [NSCLC]) has been untargetable, owing to the molecular structure which inherently prevents drug binding. KRAS mutations in NSCLC are associated with distinct clinical profiles including smokers and mucinous histology. KRAS G12C mutations account for ~40% KRAS altered NSCLC, but NSCLC being a geographically diverse disease, the features may be distinct in this part of the world. This is a single-center experience of KRAS-mutated NSCLC including clinical, imaging, pathologic features, and treatment patterns and outcomes.

METHODS

This is a single-center retrospective study of KRAS-mutated NSCLC. The clinicopathological features and outcomes were retrieved and collated from the medical record archives of the hospital.

RESULTS

Fifty (30.6%) patients with advanced-stage NSCLC with alterations in the KRAS gene were enrolled in the 163 patients who were tested for KRAS alterations. The median age was 61 years. Molecular detection revealed three main types of KRAS mutations viz-a-vis: G12C in 17 (34%), G12V in 9 (18%), and G12D in 6 (12%) patients. Comparing G12C versus the non-G12C mutated cases, co-mutations were common in the non-G12C subgroup (p < 0.05). Among the 36, who were treated at our center, all received chemotherapy as the first line with a median progression-free survival (PFS)of 5.4 months. The PFS of G12C was higher than the non-G12C subgroup (6.4 vs 3.8 months).

CONCLUSION

This is the largest single-center experience from the Indian subcontinent for KRAS-mutated NSCLC with distinct clinical features. It highlights the unmet need for G12C inhibitors in our country, where prevalence is equivalent to the West.