Les mutations de KRAS dans les cancers pulmonaires non à petites cellules, opportunités thérapeutiques et nouveaux challenges pour le pathologiste

Abstract

AbstractKRAS mutations are among the most frequent genomic alterations identified in non-squamous non-small cell lung carcinoma (NS-NSCLC), notably in lung adenocarcinoma. In most of the cases, these mutations are mutually exclusive of the different genomic alteration currently known to be sensitive to targeted therapies, notably present in EGFR, ALK, BRAF, ROS1 or NTRK. Recently, different promising clinical trials targeting KRAS G12C mutated NSCLC open new hopes for a better treatment of these tumors. In parallel, other studies have shown that NSCLC harboring co-mutations on KRAS, STK11 and KEAP1 demonstrated immunotherapy primary resistance. So, the assessment of KRAS status in late stage NS-NSCLC has become essential in order to set up an optimal therapeutic strategy in lung cancer patients. This has induced new algorithms for NSCLC sample management in the pathology laboratories and conditioned a new organization for the thoracic pathologists for an optimal health taking care of these patients.