Molecular Epidemiology of the Main Druggable Genetic Alterations in Non-Small Cell Lung Cancer

Abstract

Lung cancer is the leading cause of death for malignancy worldwide. Its molecular profiling has enriched our understanding of cancer initiation and progression and has become fundamental to provide guidance on treatment with targeted therapies. Testing the presence of driver mutations in specific genes in lung tumors has thus radically changed the clinical management and outcomes of the disease. Numerous studies performed with traditional sequencing methods have investigated the occurrence of such mutations in lung cancer, and new insights regarding their frequency and clinical significance are continuously provided with the use of last generation sequencing technologies. In this review, we discuss the molecular epidemiology of the main druggable genetic alterations in non-small cell lung cancer, namely EGFR, KRAS, BRAF, MET, and HER2 mutations or amplification, as well as ALK and ROS1 fusions. Furthermore, we investigated the predictive impact of these alterations on the outcomes of modern targeted therapies, their global prognostic significance, and their mutual interaction in cases of co-occurrence.

Keywords: ALK; EGFR; NSCLC; ROS1; lung; targeted therapy.

Figure 1

The figure depicts the main druggable genetic targets and their involvement in the main signaling pathways in non-small cell lung cancer. EGFR: epidermal growth factor receptor; HER2: human epidermal growth factor receptor 2; ERK: extracellular signal-related kinase.