Cited by 1,724Lung Cancer Treatments and MutationsCancer Genomics and DiagnosticsLung Cancer Diagnosis and Treatment

The DOI matches its Crossref record; 71 of the 71 references it cites were found in a registry or an index; none of the 15 sources its claims cite is checked for support yet.

Using Multiplexed Assays of Oncogenic Drivers in Lung Cancers to Select Targeted Drugs

Open access

Abstract

IMPORTANCE: Targeting oncogenic drivers (genomic alterations critical to cancer development and maintenance) has transformed the care of patients with lung adenocarcinomas. The Lung Cancer Mutation Consortium was formed to perform multiplexed assays testing adenocarcinomas of the lung for drivers in 10 genes to enable clinicians to select targeted treatments and enroll patients into clinical trials. OBJECTIVES: To determine the frequency of oncogenic drivers in patients with lung adenocarcinomas and to use the data to select treatments targeting the identified driver(s) and measure survival. DESIGN, SETTING, AND PARTICIPANTS: From 2009 through 2012, 14 sites in the United States enrolled patients with metastatic lung adenocarcinomas and a performance status of 0 through 2 and tested their tumors for 10 drivers. Information was collected on patients, therapies, and survival. INTERVENTIONS: Tumors were tested for 10 oncogenic drivers, and results were used to select matched targeted therapies. MAIN OUTCOMES AND MEASURES: Determination of the frequency of oncogenic drivers, the proportion of patients treated with genotype-directed therapy, and survival. RESULTS: From 2009 through 2012, tumors from 1007 patients were tested for at least 1 gene and 733 for 10 genes (patients with full genotyping). An oncogenic driver was found in 466 of 733 patients (64%). Among these 733 tumors, 182 tumors (25%) had the KRAS driver; sensitizing EGFR, 122 (17%); ALK rearrangements, 57 (8%); other EGFR, 29 (4%); 2 or more genes, 24 (3%); ERBB2 (formerly HER2), 19 (3%); BRAF, 16 (2%); PIK3CA, 6 (<1%); MET amplification, 5 (<1%); NRAS, 5 (<1%); MEK1, 1 (<1%); AKT1, 0. Results were used to select a targeted therapy or trial in 275 of 1007 patients (28%). The median survival was 3.5 years (interquartile range [IQR], 1.96-7.70) for the 260 patients with an oncogenic driver and genotype-directed therapy compared with 2.4 years (IQR, 0.88-6.20) for the 318 patients with any oncogenic driver(s) who did not receive genotype-directed therapy (propensity score-adjusted hazard ratio, 0.69 [95% CI, 0.53-0.9], P = .006). CONCLUSIONS AND RELEVANCE: Actionable drivers were detected in 64% of lung adenocarcinomas. Multiplexed testing aided physicians in selecting therapies. Although individuals with drivers receiving a matched targeted agent lived longer, randomized trials are required to determine if targeting therapy based on oncogenic drivers improves survival. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01014286.

Overview

Integrity signals

Registry

Crossref · 10.1001/jama.2014.3741

Cites

71 of 71 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

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Claims the paper makes

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Show all 27 claims

  • The quote only partly states this claim. 1
  • It may state two separate claims as one. 8
  • Probably not a substantial claim. 9
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Each contradiction between two passages listed here was confirmed by an independent check.

  • MET amplification count differs within the full-genotyping results

    Major

    MET amplification is reported in 5 of the 733 fully genotyped tumors, but the later count assigns MET amplification to 8 double-driver tumors in that group.

  • Targeted-therapy percentage is overstated

    Minor

    The reported 275 of 1007 patients is 27.3%, which rounds to 27%, not 28%.

    Reported 28 · recomputed 27.308838

  • Supplementary figure number conflicts for the exclusion analysis

    Minor

    The Results attribute the analysis excluding EGFR- and ALK-positive cancers to eFigure 6, whereas the Discussion attributes that analysis to eFigure 4.

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Metadata

Authors
Kris, M. G., Johnson, B. E., Berry, L. D., Kwiatkowski, D. J., Iafrate, A. J., Wistuba, I. I., Varella-Garcia, M., Franklin, W. A., Aronson, S. L., Su, P.-F., Shyr, Y., Camidge, D. R., Sequist, L. V., Glisson, B. S., Khuri, F. R., Garon, E. B., Pao, W., Rudin, C., Schiller, J., Haura, E. B., Socinski, M., Shirai, K., Chen, H., Giaccone, G., Ladanyi, M., Kugler, K., Minna, J. D., & Bunn, P. A.
Affiliations
  • Memorial Sloan Kettering Cancer Center (US)
  • Dana-Farber Cancer Institute (US)
  • Vanderbilt University (US)
  • Brigham and Women's Hospital (US)
  • Massachusetts General Hospital (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • University of Colorado Cancer Center Denver, Aurora
  • University of Colorado Cancer Center (US)
  • The Partners HealthCare Center for Personalized Genetic Medicine, Boston, Massachusetts
  • Winship Cancer Institute (US)
  • University of California, Los Angeles (US)
  • Johns Hopkins University (US)
  • The University of Texas Southwestern Medical Center (US)
  • Moffitt Cancer Center (US)
  • UPMC Hillman Cancer Center (US)
  • Medical University of South Carolina (US)
  • National Institutes of Health (US)
Corresponding author
Kris, Mark G.
Venue
JAMA
Published
2014-05-21
Volume
311
Issue
19
Pages
1998
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W2065477010
Cited by
1,724
References
69
Citations by year
2026: 55 · 2025: 99 · 2024: 101 · 2023: 116 · 2022: 164 · 2021: 171 · 2020: 173 · 2019: 137 · 2018: 186 · 2017: 162 · 2016: 173 · 2015: 146 · 2014: 37
FWCI
138.25
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000124)
  • National Cancer Institute (RC2CA148394, K23CA149079, P01CA129243, 1RC2CA148394‐010, P50CA058187, P30CA008748, P30CA016672, P30CA046934)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer Genomics and Diagnostics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Keywords
lung adenocarcinoma, oncogenic drivers, targeted therapy, multiplex genotyping, KRAS, EGFR, ALK rearrangement, BRAF, PIK3CA, ERBB2, MET amplification, NRAS, MEK1, AKT1, metastatic lung cancer, survival, genotype-directed therapy, clinical trial recruitment
MeSH terms
Adenocarcinoma of Lung, Adenocarcinoma, Aged, Female, Genotype, Humans, Lung Neoplasms, Male, Middle Aged, Proto-Oncogenes, Survival Analysis, Sequence Analysis, DNA, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization, Molecular Targeted Therapy, Multiplex Polymerase Chain Reaction

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