Lung cancer study points to tighter pairing of drugs to patients

The first large and comprehensive study of the genetics of a common lung cancer finds that more than half the tumors from that cancer have mutations that might be treated by new drugs that are already in the pipeline or that could be easily developed.

For the tens of thousands of patients with that cancer squamous-cell lung cancer the results are promising because they could foretell a new type of treatment in which drugs are tailored to match the genetic abnormality in each patient, researchers say.

"This is a disease where there are no targeted therapies," said Dr. Matthew Meyerson of the Dana-Farber Cancer Institute, referring to modern drugs that attack genetic abnormalities. He is a lead author of the paper, with more than 300 authors, that was published online Sunday in the journal Nature.

"What we found will change the landscape for squamous-cell carcinoma. I think it gives hope to patients," he said.

The study is part of the Cancer Genome Atlas, a large project by the National Institutes of Health to examine genetic abnormalities in cancer. The study of squamous-cell lung cancer is the second genetic analysis of a common cancer, coming on the heels of a study of colon cancer.

The work became feasible only in the past few years because of enormous advances in DNA sequencing that allow researchers to scan all the DNA in a cell instead of looking at its 21,000 genes one at a time. The result has been a new appreciation of cancer as a genetic disease, defined by DNA alterations that drive a cancer cell's growth, instead of a disease of a particular tissue or organ, such as breast or prostate or lung.

And, in keeping with the genetic view of cancer, in this study of squamous-cell lung cancer, no one mutation stood out. Different patients had different mutations.

As a result, the usual way of testing drugs by giving them to everyone with a particular type of cancer no longer makes sense. So researchers are planning a new type of testing program for squamous-cell cancer that will match the major genetic abnormality in each patient with a drug designed to attack it, a harbinger of what many say will be the future of cancer research.

Squamous-cell lung cancer, second in frequency only to adenocarcinoma of the lung, kills about 50,000 people each year. That is more than are killed by breast cancer, colon cancer or prostate cancer. As many as 30 percent of adenocarcinoma patients never smoked, but well over 90 percent of squamous-cell cancer patients are or were smokers.

Adenocarcinoma of the lung also can be easier to treat than squamous- cell cancer. About 30 percent of adenocarcinoma patients have mutations in their cancers that can be targeted by new drugs. Those drugs do not work in squamous-cell cancers, whose mutations are different.

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Lung cancer study points to tighter pairing of drugs to patients