Relevance of the novel IASLC/ATS/ERS classification of lung adenocarcinoma in advanced disease

Abstract

Since the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS) reported a new lung adenocarcinoma (ADC) classification, several groups have validated its association with prognosis in early stage disease. To our knowledge, there are no studies in advanced disease.We reviewed 313 patients with invasive lung ADC who were re-classified using the new IASLC/ATS/ERS criteria. Patients received platinum-based chemotherapy. Clinical characteristics, EGFR mutations, response and progression-free survival (PFS) after chemotherapy and overall survival were analysed.ADCs were classified as lepidic 7.4%, acinar 44.7%, papillary 10.1%, micropapillary 3.5% and solid 34.2%. When patterns were lumped into groups, response rates and PFS to platinum-based chemotherapy were better in high-grade ADC (micropapillary, papillary and solid-predominant) versus intermediate-grade ADC (lepidic and acinar-predominant) (36.9% versus 25.4% p50.034 and 6.4 versus 5.5 months p50.009, respectively). Overall survival was better in high-grade ADC (25 versus 16.8; p50.023). Factors associated with better overall survival were Eastern Cooperative Oncology Group (0-1), EGFR mutations and highgrade ADC.Prognostic differences found with the new classification in early disease may not apply to patients with advanced disease. Unlike in early stages, patients with high-grade ADC have longer overall survival compared with intermediate-grade ADC, probably due to a better response to chemotherapy. @ERSpublications Impact of the novel classification of lung adenocarcinoma in advanced disease

The ambition of theEuropean Respiratory Journal: chapter 3

“…In 2014 more than 200 original articles were published in the ERJ: we were proud to release exciting novel information covering the whole spectrum of respiratory medicine, including epidemiology [18], COPD [19][20][21], asthma [22,23], paediatric pulmonology and cystic fibrosis [24,25], tuberculosis and respiratory infections [26,27], sleep medicine [28], pulmonary vascular medicine [29,30], interstitial lung diseases [31], lung function [32] and lung cancer [33].…”

Histological grading in lung cancer: one system for all or separate systems for each histological type?

“…However, a recent study in patients with advanced disease evaluated predominant subtype in core biopsies and classified tumours with papillary-, micropapillary-and solid-predominant patterns to be high grade. Patients with these high-grade patterns had better response rates to platinum-based therapy and progression-free survival than patients with lower grade adenocarcinomas [31,32]. Further validation is needed to demonstrate clinical relevance for grading in non-resection specimens.…”

Can IASLC/ATS/ERS subtype help predict response to chemotherapy in small biopsies of advanced lung adenocarcinoma?

“…In this issue of European Respiratory Journal, CAMPOS-PARRA et al [3] present findings that suggest that using the approach to predominant pathological subtyping proposed in the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification of lung adenocarcinoma in patients with advanced disease may predict outcomes after standard chemotherapy. The IASLC/ATS/ERS classification, published in 2011, provides an overall systematic approach to analysis of lung adenocarcinomas [4].…”

“…In this context, CAMPOS-PARRA et al [3] report their evaluation of small tumour biopsies from patients with advanced lung adenocarcinomas using the new IASLC/ATS/ERS lung adenocarcinoma classification system. In a group of patients with advanced lung adenocarcinoma treated with standard first-line chemotherapy regimens, they found that high grade tumours (in this series: micropapillary, papillary and solid predominant), as compared with lower grade tumours, have a higher response rate (37% versus 25%, p50.034), progression-free survival (6.4 versus 5.5 months, p50.009) and overall survival (25 versus 17 months, p50.023).…”

“…A critically important caveat to our understanding of these data is that this study by CAMPOS-PARRA et al [3] classifies tumours from patients with metastatic disease solely based upon a single biopsy result with a small tumour sampling. Often, this is the only material available for determination of diagnosis and decisions regarding treatment.…”