Lung Cancer Update, Issue 3, 2016 (Video Program) - Video 14MET amplification and exon 14 splice site mutations define unique molecular subgroups of NSCLC
3:07 minutes.
TRANSCRIPTION:
DR LOVE: It seems like every day we hear about a new tumor mutation in lung cancer. And I see you had this paper in Clinical Cancer Research looking at MET amplification and exon 14 splice site mutation. Is this another mutation situation that an oncologist has to be aware of for practical purposes? DR MOK: Actually, this came up last year for the first time by Paul Paik and also from the Sloan Kettering group, that this is actually established to be a driver oncogene. However, last year there were not too many clinical cases that responded to crizotinib. But this year there will be 1 oral presentation on this. So I don’t have the data on hand yet. I’m waiting to hear those data in terms of the responses of the crizotinib in management of the patient with MET exon splicing. DR LOVE: But what I’ve heard is, quote, this is not rare. This is not an uncommon mutation. DR MOK: So according to the JCO paper, it’s approximately 3% of the adenocarcinoma. And then there’s almost, like, more than 20% for patients with a sarcomatoid carcinoma of the lung. DR LOVE: Sarcomatoid. DR MOK: Sarcomatoid carcinoma of the lung, or pulmonary sarcomatoid carcinoma. And again, is retrospective data but is actually quite outstanding. So right now, actually, to me, what I do is that if it’s sarcomatoid, I would test for it for sure. And then for other patients, adenocarcinoma, if they are actually so-called EGFR-negative, ALK-negative, then I may consider testing for it. For this I will just share 1 extra case with you. This is fresh. So this is 1 patient of mine who actually was initially diagnosed to have EGFR exon 19-mutation positive. For them, TKI, no response. It was scary. So I put her on chemotherapy, no response. Scary. So I gave her radiation. And then after radiation would manage to control the main tumor bulk and then put her on immunotherapy. But then the immunotherapy control was very short term. And then she come up with, in a few months, with multiple peritoneal metastases and a bowel obstruction. So we have to go in and then relieve the IO. And in the same time, we biopsied some of the tumor. We sent it out. It just came back 2 days ago, MET exon 14, skipping mutation positive.” DR LOVE: Wow! DR MOK: And I have not gone back to Hong Kong yet, but this is the one patient I’m going to start on crizotinib. DR LOVE: Huh. And had that been tested for previously? DR MOK: No. DR LOVE: So she might have had it all along? DR MOK: She may have it all along, because before, she was EGFR mutation-positive. Then I did not test for anything else. I just let it be the case. But then when I do the bowel resection, the tumor was EGFR mutation-negative. I say, “What is going on?” So I just say, “No way. Let me just send it for NGS.” And so I got this back. DR LOVE: Hmm. And in terms of this exon 14 splice mutation, that gets picked up on NGS? DR MOK: Yes. DR LOVE: Next-generation sequencing. DR MOK: Next-gen sequencing would pick it up. |