The following is a summary of “Clinical outcomes and molecular features of different histopathologic patterns in patients with stage IB non-squamous non-small-cell lung cancer,” published in the April 2023 issue of Oncology by Yue, et al.
Recurrence is possible within 5 years for 15% to 20% of patients with stage IB non-small-cell lung cancer (NSCLC). However, adjuvant therapy after stage IB resection is still controversial. To determine which patients with stage IB non-squamous NSCLC (nsNSCLC) would benefit most from adjuvant therapy, this study analyzed the prognostic and molecular variables associated with the various histopathologic patterns of nsNSCLC. Between 2014 and 2018, the study comprised 215 patients with resected pathologic stage IB (tumor size 3-4 cm) nsNSCLC from the Cancer Institute & Hospital at Tianjin Medical University. Tissues from 130 patients were sequenced for genomic profiling using a panel of 9 driver genes (OncoScreen® Focus CDx Tissue Kit, Burning Rock Biotech), and molecular risk stratification was determined using a 14-gene quantitative PCR (qPCR) assay (DetermaRxTM, Burning Rock Biotech).
About 67.9% of the 215 patients had the solid/micropapillary-predominant pattern (S/MP), 40.5% had platinum-based doublet adjuvant chemotherapy, and 5.1% had received adjuvant targeted therapy with or without chemotherapy. DFS was considerably lower for patients with the S/MP pattern compared to those with the lepidic/acinar/papillary-predominant (L/A/P) pattern (hazard ratio [HR]: 2.16, 95% CI: 1.28 to 3.67; P=0.013). Adjuvant treatment was not helpful for either pattern either. The EGFR mutation was found in 75 of 126 patients (59.5%), with a considerably lower positive rate in the S/MP pattern than in the L/A/P pattern (50.6% vs. 79.5%, P=0.002). However, in both the general population and among the various histopathologic subtypes, EGFR mutation status was not a predictor of DFS.
Adjuvant-targeted therapy helped EGFR-mutant patients, at least in the available samples. Among the 99 patients who had their molecular risk assessed, 37.4%, 26.3%, and 36.4% were correctly classified as having a molecularly high risk, intermediate risk, or low risk. High-risk patients were more likely to have an S/MP pattern than low-risk patients were to have a L/A/P pattern (46.2% vs. 20.6%; 26.2% vs. 55.9%; P=0.009). High-risk patients, especially those with an S/MP pattern (HR, 3.45, 95% CI, 1.46-8.15; P=0.017), had a substantially shorter DFS than low-risk patients (HR, 2.93, 95% CI, 1.31-6.54; P=0.012). There are substantial differences in molecular characteristics between the S/MP pattern and the other histopathologic subtypes of nsNSCLC, as confirmed by this investigation. Those with a poorer prognosis in the S/MP pattern could be accurately identified using a qPCR-based assay, suggesting that these patients would reap the greatest benefits from individualized adjuvant therapy.
Source: abstractsonline.com/pp8/#!/10828/presentation/2832
