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Improving Discoveries and the Treatment of Lung Cancer Mutations
By David Kuperman, MD

Lung cancer is a challenging foe. It is the biggest cause of cancer death in the United States and is the subject of much research into improved screening and treatment. Although progress has been slow, significant improvements are being made.

Lung cancer is traditionally divided into two types: small cell and non-small cell carcinomas. They are treated differently. It was not all that long ago staging (where the cancer is located) and identifying whether it was small cell or non-small cell was all the information needed for making a treatment plan. This is no longer the case. Further information on the presence of mutations found in certain lung cancers can guide therapy.

The mutations in non-small cell lung cancers that have gained the most attention are changes in the Epidermal Growth Factor Receptor (EGFR) and in the ALK gene. In approximately 15 percent of certain non-small cell lung cancers, a mutation in the EGFR gene is present. It is more commonly found in patients with lung cancer who never smoked. Erlotinib (Tarceva ) is an oral medication that is targeted to treat this mutation. This targeted therapy is both more effective and has fewer side effects than standard chemotherapy.

ALK mutations are found in approximately four percent of patients with non-small cell lung cancer. They are more likely to be found in younger patients and those who did not smoke. Crizotinib (Xalkori ) is an oral medication that is targeted to treat this mutation. It has also been found to be more effective and has fewer side effects than standard chemotherapy.

While the majority of patients do not have EGFR and ALK mutations, they are a significant advancement in therapy. They represent a first step towards truly personalized and effective therapies for lung cancer. Further investigations are ongoing.

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