Lung cancer in never smokers from the Princess Margaret Cancer Centre
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Grzegorz J. Korpanty1, Suzanne Kamel-Reid2, Melania Pintilie1, David M. Hwang3, Alona Zer1, Geoffrey Liu1, Natasha B. Leighl1, Ronald Feld1, Lillian L. Siu1, Philippe L. Bedard1, Ming-Sound Tsao3 and Frances A. Shepherd1
1Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
2Laboratory Genetics, University Health Network, Toronto, ON, Canada
3Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
Grzegorz J. Korpanty, email: [email protected]
Keywords: lung cancer; never smokers; targeted therapy
Received: September 27, 2017 Accepted: March 23, 2018 Published: April 27, 2018
Introduction: Lung cancer in never smokers represents a distinct epidemiological, clinical, and molecular entity.
Results: Most 712 never smoking lung cancer patients were female (72%) with a median age at diagnosis of 62.2 years (18–94). Caucasians (46%), East Asians (42%), adenocarcinoma histology (87%) and presentation with metastatic disease at diagnosis (59%) were common. Of 515 patients with available archival tissue, the most common identified single mutations were EGFR (52.2%), followed by ALK (7.5%), KRAS (2.3%), TP53 (1.3%), ERBB2 (1%), BRAF (0.4%), PIK3CA (0.4%), SMAD4 (0.4%), CTNNB1 (0.2%), AKT1 (0.2%), and NRAS (0.2%); 8% tumors had multiple mutations, while 25.8% had none identified. Median overall survival (mOS) was 42.2 months (mo) for the entire cohort. Patients with mutations in their tumors had significantly better mOS (69.5 mo) when compared to those without (31.0 mo) (HR = 0.59; 95% CI: 0.44–0.79; p < 0.001). Earlier stage (p < 0.001), adenocarcinoma histology (p = 0.012), good performance status (p < 0.001) and use of targeted therapy (p < 0.001) were each independently associated with longer survival. Patients with ALK-translocation-positive tumours have significantly longer OS compared to those without any mutations (p = 0.0029) and to those with other and null mutations (p = 0.022).
Conclusions: Lung cancer in never smokers represents a distinct clinical and molecular entity characterized by a high incidence of targetable mutations and long survival.
Methods: We analyzed retrospectively the data from electronic patient records of never smokers diagnosed with lung cancer treated at the Princess Margaret Cancer Centre (Toronto) between 1988–2015 to characterize demographic and clinical features, pathology, molecular profile (using hotspot or targeted sequencing panels), treatment and survival.
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