Oncogenic drivers in daily practice improve overall survival in patients ă with lung adenocarcinoma
Résumé
Background. - EGFR tyrosine kinase inhibitors and crizotinib are ă nowadays the optimal treatment for metastatic lung cancer with ă activation of EGFR mutations and ALK rearrangement. In addition, several ă targeted agents are in development for lung cancer with other ă oncodrivers. In France, since 2011, six oncodrivers are routinely tested ă in patients with stage IV. The aim of this study was to assess whether ă systematic detection of oncodrivers and matched targeted therapy improve ă overall survival in patients with advanced lung adenocarcinoma. ă Methods. - This study included all consecutive patients treated in our ă department for advanced lung adenocarcinoma from January 2012 to ă December 2013. We studied the impact in survival according to the ă presence of the driver and the targeted therapy. ă Results. - Among the 261 patients included, oncodrivers alterations were ă found in 43.5% of patients: EML4-ALK fusion genes (2.1%), EGFR ă (10.3%), KRAS (27.7%), BRAF (2.5%), HER2 (0.8%), and PI3KCA (0.8%) ă mutations. Twenty-nine percent of patients (n = 32) with oncodrivers ă received matched targeted therapy. Patient treated by targeted agent ă appropriate to an oncogenic driver had a median survival of 21.1 months ă (95% CI: 14.7-27.5). The patients (n=79) who did not receive targeted ă therapy had a median survival of 6.6 months (95% CI: 4.3-8.9). The ă patients (n = 150) without identified driver had a median survival of ă 9.7 months (95% CI: 6.7-11.7); P < 0.001. ă Conclusion. - An actionable oncodriver was routinely detected in nearly ă half of patients with advanced lung adenocarcinoma. This systematic ă detection may influence treatment outcomes, notably with matched ă targeted therapy. (C) 2016 SPLF. Published by Elsevier Masson SAS. All ă rights reserved.