Monday, April 1, 2013

From Kirtee Raparia: Molecular Profiling in Non–Small Cell Lung Cancer: A Step Toward Personalized Medicine

http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2012-0287-RA


Molecular Profiling in Non–Small Cell Lung Cancer: A Step Toward Personalized Medicine

Kirtee Raparia MDCelina Villa MDMalcolm M. DeCamp MDJyoti D. Patel MDMinesh P. Mehta MD
From the Department of Pathology (Drs Raparia and Villa); the Division of Thoracic Surgery (Dr DeCamp); the Division of Medical Oncology (Dr Patel); the Department of Radiation Oncology, Feinberg School of Medicine, Chicago (Dr Mehta); and the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Drs Raparia, DeCamp, Patel, and Mehta).
Context.—Lung carcinoma is the result of sequential accumulation of genetic and epigenetic changes. Lung adenocarcinoma is a heterogeneous disease with diverse somatic mutations, and several of them include the so-called driver mutations, which may serve as “druggable” therapeutic targets. Thus, development of personalized approaches for the treatment of non–small cell lung carcinoma (NSCLC) mandates that pathologists make a precise histologic classification inclusive of routine molecular analysis of such tumors.
Objective.—To address the molecular mechanisms underlying NSCLC and how this knowledge reflects the multidisciplinary approach in the diagnosis and management of these patients. We will also summarize the current available and investigational personalized therapies for patients with resectable early-stage, unresectable locally advanced, and metastatic NSCLC.
Data Sources.—Peer-reviewed published literature and personal experience.
Conclusions.—There are multiple mechanisms involved in the pathogenesis of lung cancer, which operate in parallel and involve pathways of activation and inhibition of various cellular events. Further research is essential to characterize the histologic and mutational profiles of lung carcinomas, which will ultimately translate into improved and more personalized therapeutic management of patients with lung cancer.



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