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Personalized Treatment Using Mutational Analysis

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Traditional chemotherapy for lung cancer represents the use of medications, usually given intravenously (by injection) which tend to be relatively non-specific in their ability to destroy cancer cells in the body. Given this non-specific nature of chemotherapy, many “innocent bystander” cells in the body which are not cancerous are also destroyed, which is responsible for the toxicity (side effects) of traditional chemotherapy. New drugs (called targeted therapies) are being discovered which act much more specifically on cancer cells, sparing more of the normal cells, resulting in less toxicity.

Despite these breakthroughs, only a minority of patients’ tumors will respond favorably to the new targeted therapies, but when they do respond, the results can be dramatic. Personalized medicine describes the process of identifying which patients will respond to which medications, so that drugs are not used “blindly” in patients where they won’t work.

The Epidermal Growth Factor Receptor (called EGFR) is a molecule on the surface of many cells in the body, both malignant (cancerous) and benign (noncancerous). Activation of EGFR on cells in the body can cause cells to behave in a malignant fashion, and promote tumor growth. Some cancer cells will lose their ability to regulate how much EGFR is on their surface, which may be caused by a mutation (abnormality) in the cells’ genes (cellular blueprint). Identification of EGFR mutations in lung cancer becomes important because a new class of drugs, called EGFR inhibitors, have become available as effective treatments in some lung cancer patients.

At The Lung Cancer Center at The Valley Hospital, identification of EGFR mutations (called Mutational Analysis) is performed routinely in all surgical specimens from lung cancer patients to determine if they will respond to EGFR inhibitors. In addition, for patients who don’t undergo surgical removal of their tumors, all available biopsy specimens undergo Mutational Analysis as well. It is important to understand that the most useful information about EGFR is obtained using Mutational Analysis, as opposed to simple EGFR staining, which many other institutions may substitute because it is easier to perform.

In addition to EGFR, Lung Cancer Center pathologists also perform other molecular tests on patients’ tumors, including Kras Mutational Analysis (an indicator of lung cancer aggressiveness) and ERCC1 expression (and indicator of sensitivity to chemotherapy). Personalized medicine and targeted therapies represent the future of cancer treatment, because they will clearly enhance both the quality of life and longevity for cancer patients.

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