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Lynne Eldridge MD

For Young People With Lung Cancer, Genes Are Important

By February 6, 2013

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Lung cancer happens in people who are young.

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Sitting at a table at the LUNGevity HOPE Summit last year I was blown away one morning. I was the oldest cancer survivor at the table. Being the oldest wasn't what surprised me (even though I'm not that old.) If I had been among a group of people with leukemia or Hodgkin's lymphoma, or even among other people with breast cancer like myself, I wouldn't have been particularly surprised. But the young people I was sitting with were all lung cancer survivors.

As I looked around the room I noted many differences between the older people and younger people in the room. Differences in hair styles. Differences in clothing choices. Differences in interests ranging from serious biking to bridge. So why do we treat everyone with lung cancer the same medically?

In fact we don't. We are starting to "personalize" lung cancer treatment by figuring out molecular profiles that make a cancer unique. And drugs targeting these unique features are making a difference for a subset of people with lung cancer.

A small percentage - 10 to 15% -- of people with lung cancer have what is called an EGFR mutation. This is a mutation in a gene that codes for a protein that plays a role in the growth of cancer. For some people with the mutation, the medication Tarceva (erlotinib) - an EGFR inhibitor - has improved survival beyond that previously possible.

An even smaller percentage (perhaps 3 to 4%) of people have a different mutation called an ALK mutation (or EML4-ALK fusion gene for those who want to get technical.) Only recently was a medication (Xalkori (crizitonib)) approved that may prolong survival for people with this mutation.

With these treatments available, more and more people are being tested for these mutations - something called molecular profiling. I don't have any good numbers, but it's clear from lung cancer survivors I meet that not everyone has been tested. Testing seems to be more common in women and non-smokers - groups that have a greater likelihood of having these mutations. But what about young people? Are they more or less likely to harbor these mutations, or doesn't age really matter?

Researchers conducted a small study to answer just this question. The examined people with lung adenocarcinoma who were 40 years of age or younger. The results? 75% of the "youngsters" had one of these mutations. Unlike the 3-4% of ALK mutations overall, the incidence was close to 50%.

The conclusion of the study?

In order to receive the best treatment possible, young patients with lung cancer should have their cancer tissue examined for these gene abnormalities. If you fit this age group, check with your oncologist to see if molecular profiling was done on your tumor.

Photo: National Cancer Institute, Daniel Sone (photographer)

Source

Nagashima, O. et al. High prevalence of gene abnormalities in young patients with lung cancer. Journal of Thoracic Disease. 2013. 5(1):27-30.

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