You may be surprised to learn that lung cancer is the leading cause of cancer deaths in both men and women in the United States. However, in the past few years, tremendous progress has been made leading to improved outcomes for patients with lung cancer. According to the Centers for Disease Control and Prevention, genomics is “the study of all the genes in a person, as well as the interactions of those genes with each other and a person’s environment.” While 99.9% of everyone’s genetic makeup is identical, the difference in the remaining 0.1% helps inform researchers about disease. For patients with certain subtypes of lung cancer, we have now made genomic testing of tumors a routine part of care. Understanding that each person has a unique genetic makeup allows for individualized treatment for patients with specific mutations in their tumor tissues.
Lung cancer is broadly divided into two types: non-small cell lung cancer and small cell lung cancer. Approximately 85% of lung cancers are of the non-small cell lung cancer category, which consists of three major subtypes: adenocarcinoma, squamous cell carcinoma and large cell carcinoma.
Adenocarcinoma accounts for nearly 50% of all non-small cell lung cancers and has had an increasing rate of incidence in the United States over the past few years. During the same time, we have learned a lot about the biology of lung cancer overall. As a result, sophisticated tests are now available to identify specific mutations in tumors of patients with adenocarcinoma of the lung. For example:
- A gene called epidermal growth factor receptor (EGFR) is mutated in nearly 15% of patients with adenocarcinoma. After years of research, we now know that treatment for these patients involves an orally administered targeted drug, versus combination chemotherapy. These novel treatments result in significant improvement of symptoms, disease control and survival.
- Through other research, we now know that another group of patients with adenocarcinoma carries a mutation in a gene called ALK. For these patients, an FDA-approved treatment option named crizotinib is used, which has been found to provide great benefits to these patients.
Since it has been identified that a person’s genetic makeup plays a significant role in not only understanding their overall health and disease occurrence, but also the ideal treatment method(s) they should receive, nowadays, almost every patient diagnosed with lung adenocarcinoma is genetically tested for specific mutations. The good thing about this test is that it can usually be performed from already collected specimens used to diagnose lung cancer, therefore eliminating the need for additional invasive procedures.
At the Winship Cancer Institute of Emory University, we have implemented a standardized molecular testing protocol for every patient diagnosed with lung adenocarcinoma. As a result, in most circumstances, when an oncologist sees a patient for the first time, detailed molecular information is available on the tumor tissue, which helps inform treatment decisions.
Unfortunately, for certain mutations, there are currently no FDA-approved treatment options. Yet, as Georgia’s first and only National Cancer Institute –designated cancer center, Winship offers a number of innovative clinical trials for such patients, with the aim of identifying treatment options that provide the best likelihood of success.
Through research and clinical trials, investigators and physicians have discovered that understanding the genetic makeup of lung cancer patients is key. This knowledge allows for optimal, individualized treatment options that lead to overall improved outcomes for our patients.
About Dr. Ramalingam
Suresh Ramalingam, MD, is Associate Professor of Hematology and Medical Oncology and Director of the Translational Thoracic Malignancies Program for the Emory Winship Cancer Institute. He is a Georgia Cancer Coalition Distinguished Cancer Clinician and Scientist.
Prior to joining Emory, Dr. Ramalingam was at the University of Pittsburgh Cancer Institute. He specializes in lung cancer, esophageal cancer and other thoracic cancers and is actively involved in the scientific development of novel anti-cancer treatment agents.
Dr. Ramalingam serves as the principal investigator on several early phase clinical trials in lung cancers, many of which are sponsored by the NCI. He is widely published in peer-reviewed scientific journals and serves as a reviewer for a number of medical journals. Dr. Ramalingam is a member of the Thoracic Core Committee of the Eastern Cooperative Oncology Group and serves on the editorial board of the journal Clinical Lung Cancer.
He earned his medical degree at the University of Madras in India, and served as chief medical resident in Internal Medicine at Wayne State University in Detroit. He later conducted his fellowship in hematology and oncology at the University of Pittsburgh Cancer Institute.
Dr. Ramalingam is a recipient of the prestigious “Clinical Research Career Development Award,” which is presented by the American Society of Clinical Oncology. He has been selected as one of “The Best Doctors in America” and has received numerous awards of excellence such as The University of Pittsburgh Leadership Award for Excellence in Clinical Trials Program Development.