Malignant pleural disease is highly associated with subsequent peritoneal metastasis in patients with stage IV non-small cell lung cancer independent of oncogene status

Presence of pleural effusion is associated with a poor prognosis in patients with epidermal growth factor receptor-mutated lung cancer receiving tyrosine kinase inhibitors as first-line treatment

“…In ovarian cancer patients, some EGFR activators (heparin‐binding epidermal growth factor–like growth factor, endothelin‐1, and lysophosphatidic acid) was found in ascites that may regulate EGFR activity and possibly play a pivotal role in tumor cells . A retrospective study also observed a high incidence (64.7%) of detectable resistance (either EGFR T790M or MET gene amplification) in patients with pleural metastasis during the course of their disease, which progressed to peritoneal metastasis . Further research on this issue may assist in elucidating the resistance to EGFR TKIs.…”

ROS1-rearranged lung adenocarcinoma with peritoneal carcinomatosis on initial presentation

“…It could be that presence of driver mutation can be related to faster disease progression and development of PC. Nevertheless, larger studies did not identify statistically significant association between development of PC and presence of EGFR, KRAS and ALK mutations 5 6. There is very limited data on impact of the rare mutations including ROS1, MET and BRAF on development of PC in lung cancer patients.…”

“…The most common histological type associated with the peritoneal metastasis is adenocarcinoma 5. Many patients with PC have malignant pleural effusions suggesting that peritoneal spread may be related to serosal communication with metastatic seeding, however, cases of isolated PC without pleural or other site metastasis have been reported 6 9. It has been suggested that oncogene status of the tumour can influence the patterns of metastatic spread 7.…”

“…Peritoneal spread is rare in lung cancer with a reported incidence of 1.2% on clinical diagnosis 4. Peritoneal carcinomatosis (PC) usually develops late in the disease process and is rarely seen at the time of cancer diagnosis 5 6. There are limited data on the factors that predict peritoneal progression.…”

“…It has been proposed that the oncogene profile of the tumour might predispose to different metastatic patterns 7. Several common mutations have been analysed including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and Kirsten rat sarcoma (KRAS) viral oncogene, but no statistically significant association with PC was found 5 6. On review of the literature published in English, testing for c-ROS oncogene 1 (ROS1) was reported only in three patients with non-small cell lung cancer (NSCLC) with peritoneal spread and returned positive in one of them.…”