Abstract
Lung cancer research has recently made significant progress in understanding the molecular pathogenesis of lung cancer and in developing treatments for it. Such achievements are directly utilized in clinical practice. Indeed, the echinoderm microtubule-associated protein-like 4–anaplastic lymphoma kinase (ALK) fusion gene was first described in non-small cell lung cancer in 2007, and a molecularly targeted drug against the fusion was approved in 2011. However, lung cancer with the ALK fusion constitutes only a small fraction of lung cancers; therefore, efficient patient selection is crucial for successful treatment using the ALK inhibitor. Currently, RT-PCR, fluorescent in situ hybridization (FISH), and immunohistochemistry are commonly used to detect the ALK fusion. Although FISH is currently the gold standard technique, there are no perfect methods for detecting these genetic alterations. In this article, we discuss the advantages and disadvantages of each method and the possible criteria for selecting patients who are more likely to have the ALK fusion. If we can successfully screen patients, then ALK inhibitor treatment will be the best example of personalized therapy in terms of selecting patients with an uncommon genotype from a larger group with the same tumor phenotype. In other words, the personalized therapy may offer a new challenge for current clinical oncology.
Highlights
Lung cancer research has recently made significant progress in understanding the molecular pathogenesis of lung cancer and in developing treatments for it
epidermal growth factor receptor (EGFR)–TKIs are the first-line treatments for patients with advanced disease when the tumor is positive for the EGFR mutation
A marked response to an anaplastic lymphoma kinase (ALK) inhibitor was demonstrated in patients with ALK fusion-bearing lung cancer (Kwak et al, 2010)
Summary
Lung cancer research has recently made significant progress in understanding the molecular pathogenesis of lung cancer and in developing treatments for it. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR–TKIs) have been developed, and a subset of lung cancer patients have shown dramatic therapeutic responses to these treatments. This superior response was revealed to be associated with the EGFR mutation, which was identified in 2005 (Lynch et al, 2004; Paez et al, 2004). One-third of lung cancer patients are diagnosed with localized disease that can be treated by surgical resection (Molina et al, 2006); nearly 30–35% will relapse after the initial surgery, even following a diagnosis at the earliest stage For these patients, the surgically resected tissue may serve as an important sample for further molecular study because the recurrent tumor is often impossible to access without invasive procedures. Before explaining the details of these methods, we will consider whether the targeted patient population can be identified based on their clinicopathological features
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
