Do “pan-negative” never-smoker (NS) lung cancer patients (pts) represent a new distinct subgroup? Data from a single-institution experience.
Authors: Chiara Bennati, Rita Chiari, Giulio Metro, Daniela Iacono, Vincenzo Minotti, Chiara Scafati, Annamaria Siggillino, Lorenza Pistola, Maria Francesca Currà, Massimiliano Ferraldeschi, Diana Giannarelli, Lucio Crino
Journal: Journal of Clinical Oncology (2014)

Article Tools Lung Cancer—Non-Small Cell Metastatic Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/jco.2014.32.15_suppl.e19054 Journal of Clinical Oncology - published online before print May 20, 2014 Do “pan-negative” never-smoker (NS) lung cancer patients (pts) represent a new distinct subgroup? Data from a single-institution experience. Chiara BennatixChiara BennatiSearch for articles by this author , Rita ChiarixRita ChiariSearch for articles by this author , Giulio MetroxGiulio MetroSearch for articles by this author , Daniela IaconoxDaniela IaconoSearch for articles by this author , Vincenzo MinottixVincenzo MinottiSearch for articles by this author , Chiara ScafatixChiara ScafatiSearch for articles by this author , Annamaria SiggillinoxAnnamaria SiggillinoSearch for articles by this author , Lorenza PistolaxLorenza PistolaSearch for articles by this author , Maria Francesca CurràxMaria Francesca CurràSearch for articles by this author , Massimiliano FerraldeschixMassimiliano FerraldeschiSearch for articles by this author , Diana GiannarellixDiana GiannarelliSearch for articles by this author , Lucio CrinoxLucio CrinoSearch for articles by this author Show More Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy; Division of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy; Division of Medical Oncology, S Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy; Division of Medical Oncology, Azienda Ospedaliera, Perugia, Italy; Medical Oncology, S Maria della Misericordia Hospital, Azienda Ospedaliera Perugia, Perugia, Italy; Regina Elena National Cancer Institute, Rome, Italy; University of Perugia, Perugia, Italy Abstract Disclosures https://doi.org/10.1200/jco.2014.32.15_suppl.e19054 Abstract Abstract e19054 Background: Identification of oncogenic drivers has dramatically changed current therapeutic strategies for lung cancer, initiating the era of personalized therapy. "Pan-negative" NS non-small cell lung cancers (NSCLC) represent an exciting challenge to discover rare gene fusions and to define the best treatment options. Methods: From a 243 never-smoker NSCLC database, we identified 113 oncogene-addicted lung tumors, analyzed for a 5-genes panel: EGFR, K-RAS, ALK, ROS1, HER2. Out of the 130 pan-negative pts, we were able to collect archived histological material of 29, to be analyzed for RETgene rearrangement, through the FISH test. Outcomes to first line chemotherapy and TKI treatment, were evaluated by Cox multivariate analysis. Results: Patients characteristics: good clinical conditions (PS ECOG 0-1), predominance of female sex (21 pts, 64%), median age 55 (23-81), advanced moderately and poorly differentiated adenocarcinomas. In our cohort, 3 RET+ cases (10%) were identified, one compatible with KIF5B:RET and the other two with a non-KIF5Bfusion partner. There was no difference neither in progression free survival (PFS) (9 months, mo) for both groups nor in overall response rate (ORR) (66.7% vs 50%; p=0.24) for pts treated with a pemetrexed-based regimen (15 pts, 52%) as compared with the non-pemetrexed group (14 pts, 48%). Median overall survival (OS) of the pts who received pemetrexed was 17 mo compared to 25 mo of the non-pemetrexed subgroup (p=0.03). In our cohort 13 pts received an oral TKI. Median OS showed no significant differences between TKI and not-TKI treatment (22 vs 23 mo, p=0.94). Conclusions: Our study in a highly selected population confirms the lack of benefit in any of the outcome measures in the absence of a genetic driver. Longer survival in “pan-negative” NS lung cancer pts compared to an unselected NSCLC population is probably a result of their distinct clinical features. © 2014 by American Society of Clinical Oncology