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Practical Value of Molecular Pathology in Stage I–III Lung Cancer: Implications for the Clinical Surgeon

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Over a decade since the discovery of EGFR mutation, and 6 years since prospective clinical trial data proved that routine molecular pathology tests improve survival in stage IV lung cancer, there is still debate whether to test patients with earlier stages of disease (stage I–III). As discoveries of targeted drugs for stage IV patients accelerate—prompting routine testing for ALK, ROS1, RET, BRAF V600E, and HER2, among others—there is an argument that all lung cancers should be genotyped for the purpose of classification, regardless of stage of disease. The counterargument is that because targeted drugs have only been validated for use in stage IV disease, these molecular tests need only be conducted at the time of disease recurrence. This review will describe current, practical applications of molecular pathology testing in early stage lung cancer, focusing on the immediate diagnostic, prognostic, and therapeutic implications for individual patient management. Meanwhile, large-scale clinical trials are underway to test targeted drugs as adjuvant therapies in patients with early stage disease.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Thoracic Oncology Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Christopher G. Azzoli MD

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  1. Christopher G. Azzoli MD
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Correspondence to Christopher G. Azzoli MD.

Additional information

Acknowledgement This educational review series, “Genomic Markers in the Multidisciplinary Treatment of Cancer” is supported by an independent educational grant from Genomic Health, Inc. The Society of Surgical Oncology offers CME/MOC for this educational review series. Visit moc.surgonc.org for additional information.

Annals of Surgical Oncology educational reviews represent the journal’s commitment to the peer review and publication of high quality research necessary to define the safety, toxicity, or effectiveness of potential therapeutic agents compared with conventional alternatives.

This Educational Review Series may include information regarding the use of medications that may be outside the approved labeling for these products. Physicians should consult the current prescribing information for these products. Authors of Annals of Surgical Oncology educational reviews are provided at the time of article solicitation with this statement regarding off-label pharmaceutical information and research.

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Azzoli, C.G. Practical Value of Molecular Pathology in Stage I–III Lung Cancer: Implications for the Clinical Surgeon. Ann Surg Oncol 22, 3459–3465 (2015). https://doi.org/10.1245/s10434-015-4704-z

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  • DOI: https://doi.org/10.1245/s10434-015-4704-z

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