Lung cancer: advances in personalized medicine

Several new studies that may help doctors tailor lung cancer treatment to the characteristics of individual patients and of their tumors were presented at the 3rd European Lung Cancer Conference in Geneva. "A major goal of lung cancer treatment is to tailor the treatment to the individual," says Dr Fiona Blackhall from The Christie NHS Foundation Trust in Manchester, UK. "The studies that will be presented at ELCC 2012 are important practical steps to achieving this in the clinic. Methods ranging from convenient blood-based molecular tests, detailed genetic analysis of tumors and functional imaging techniques have been applied in patient populations receiving a range of treatments. These findings provide impetus to continue developing a personalized medicine approach to lung cancer with the overall aim of selecting the most effective treatment for the individual." Proteins provide clues to outcomes An international group of researchers report promising results with a test that may identify patients likely to benefit from first-line therapy with a particular drug combination. Dr Oliver Gautschi from the Swiss Group for Clinical Cancer Research (SAKK), and collaborators from The Netherlands and the US company developing the test, conducted a retrospective analysis of two phase-II trials with a serum proteomic classifier called VeriStrat®. Their aim was to evaluate the prognostic value of the test in patients with advanced non-small cell lung cancer receiving first-line treatment with bevacizumab and erlotinib. VeriStrat® uses mass spectrometry to measure proteins in pre-treatment blood and assigns a result that correlates with outcome from treatment with a class of drugs known as EGFR inhibitors, which includes erlotinib and gefitinib. The test was initially developed and validated in patients who had already been treated with chemotherapy, and who then received an EGFR inhibitor in second line, Dr Gautschi explains. "We conducted this project to see if the test is also prognostic in untreated patients who received an EGFR inhibitor in the first line. Until now, this has not been clear." The researchers used VeriStrat® to analyze blood samples from 117 patients previously enrolled in two phase II trials and compared the results to the patients' progression-free survival and overall survival. The analysis showed that those classified by the test as likely to have better outcomes on EGFR inhibitor therapy did indeed live longer. "The difference in overall survival between patients classified by the test as likely to have better or worse outcomes when receiving EGFR inhibitors was clinically relevant," Dr Gautschi said. However he noted that definitive conclusions about the use of this test in previously untreated patients requires further studies. "There is an unmet need for reliable blood-based markers in patients with lung cancer, because lung tumors are harder to biopsy than breast tumours for example. The current study indicates that modern technologies, such as proteomics, are promising tools, which need further validation in large trials," he said. In this context, the European Thoracic Oncology Platform (ETOP) is currently launching a prospective phase-III trial to futher validate this test in patients with lung cancer.