Diffuse Lung Metastases in EGFR-Mutant Non-Small Cell Lung Cancer.

Subba R Digumarthy,P Gabriel Peterson,Zofia Piotrowska,Atul Padole,Lecia V Sequist,Dexter P Mendoza,Tianqi Chen

doi:10.3390/cancers11091360

Abstract

Diffuse lung metastases have been reported in non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. The purpose of our study was to compare the incidence of diffuse lung metastases in EGFR-mutant NSCLC and EGFR-wild type NSCLC and to assess other imaging features that may be associated with diffuse lung metastases in EGFR-mutant NSCLC. Two radiologists retrospectively reviewed pre-treatment imaging of metastatic NSCLC cases with known EGFR mutation status. We assessed the imaging features of the primary tumor and patterns of metastases. The cohort consisted of 217 patients (117 EGFR-mutant, 100 EGFR wild-type). Diffuse lung metastasis was significantly more common in EGFR-mutant NSCLC compared with wild-type (18% vs. 3%, p < 0.01). Among the EGFR-mutant group, diffuse lung metastases were inversely correlated with the presence of a nodule greater than 6 mm other than the primary lung lesion (OR: 0.13, 95% CI: 0.04–0.41, p < 0.01). EGFR mutations in NSCLC are associated with increased frequency of diffuse lung metastases. The presence of diffuse lung metastases in EGFR-mutant NSCLC is also associated with a decreased presence of other larger discrete lung metastases. EGFR mutations in NSCLC should be suspected in the setting of a dominant primary lung mass associated with diffuse lung metastases.

Highlights

Current guidelines recommend routine molecular testing for patients with metastatic non-small cell lung cancer (NSCLC) [1,2]
We found that the presence of diffuse lung metastases in the setting of epidermal growth factor receptor (EGFR)-mutant NSCLC is inversely correlated with the presence of larger discrete metastatic nodules
There was almost a six-fold increased incidence (18% vs. 3%) of diffuse lung metastases in patients with metastatic EGFR-mutant NSCLC compared to patients with EGFR-wild type NSCLC

Summary

Introduction

Current guidelines recommend routine molecular testing for patients with metastatic non-small cell lung cancer (NSCLC) [1,2]. In those identified to have tumors with actionable somatic alterations, target-specific tyrosine kinase inhibitors (TKIs) are the preferred first-line treatment [1]. Five drugs targeting EGFR-mutant NSCLC are currently FDA-approved as front-line therapy [5,6,7,8,9] This trend towards personalized, precision medicine in the treatment of NSCLC and the indispensable nature of imaging in the management of NSCLC have led to increased interest in radiogenomics and the correlation of radiologic features with genetic mutations. Several groups have investigated and reported the imaging findings of different genetic mutational subtypes

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