Raghava R. Induru, MD
Molecular subtyping through next-generation sequencing has revolutionized the treatment paradigm of lung cancer diagnosis and treatment, according to Raghava R. Induru, MD.
Common mutations, such as EGFR
, and ROS1
, have a pool of established therapeutic options; however, other mutations exist in the population of patients with non–small cell lung cancer (NSCLC) that are less frequent with, correspondingly, fewer treatment choices.
Patients with NSCLC who harbor BRAF mutations—a mutation commonly found in melanoma—have seen success with the combination treatment of dabrafenib (Tafinlar) and trametinib (Mekinist), which was approved by the FDA in June 2017 for patients with metastatic BRAF
“We want to look at lung cancer as a puzzle with several pieces, rather than as a single entity,” said Induru. “We are moving away from histology-based treatment to more molecular-based treatment—which is actually the definition of precision medicine. There is a huge role for next-generation sequencing as we move forward. And, if we use the targeted treatments more effectively, they will become the standard of care.”
These mutations were discussed in a lecture by Induru at the 2017 OncLive®
State of the Science SummitTM
on Advanced Non–Small Cell Lung Cancer. In an interview during the meeting, Induru, a medical oncologist at the Levine Cancer Institute, shed light on lesser-known mutations in NSCLC, such as TRK
OncLive: Please provide an overview of your presentation.
: The entire paradigm of treatment and testing in lung cancer has completely changed, and will continue to evolve over the next several years. From the common concept of lung cancer to molecular subtyping, the door has opened for newer and better treatments, which improve the quality of life of all patients with lung cancer.
The big 3 mutations are well known—EGFR
, and ROS1
—and there are several treatment options available for each. We want to continue to look at other mutations that open more treatment options. Some of them are evolving more rapidly and some are slower. Some of the clinical trials have been disappointing, while some have been very encouraging.
The 2 most important of the lesser-known mutations are BRAF, for which the combination of dabrafenib and trametinib has been FDA approved, as well as the role of a new targeted therapy called entrectinib in TRK1
-, and TRK3
-mutated lung cancers.
We see [these advances] as a movement toward precision medicine, as we can subtype lung cancer as personalized as possible, and direct treatment accordingly. This will improve outcomes.
Let's zero in on BRAF. Can you discuss this mutation as a target?
BRAF is a well-known mutation in melanoma—that is where it first gained popularity—and V600E is the most common of that mutation found in lung cancer. It is found in about 3% of patients with NSCLC, and it is not exclusive to never-smokers, unlike what we see with EGFR
, and ROS1
mutations. Instead, this is found in smokers—over 60% of smokers could harbor this mutation. Which means the actual number of patients with lung cancer who have this mutation could be much higher than patients with ALK