Targeted therapies in bronchioloalveolar carcinoma

Abstract

Bronchioloalveolar carcinoma (BAC) is a subtype of adenocarcinoma with unique epidemiology, pathology, clinical features, radiographic presentation, and natural history compared with other non-small cell lung cancer (NSCLC) subtypes. According to criteria of the revised 2004 World Health Organization classification it accounts for only 5% of all cases of NSCLC. BAC cases are mostly represented by females and non-smokers and are diagnosed at a younger age. Patients with resected BAC have prolonged survival and a lower recurrence rate after surgical resection than other NSCLC subtypes. In advanced BAC cytotoxic chemotherapy seems as effective as in other NSCLC, although studies on pure BAC are based on small numbers of patients and mainly tested paclitaxel based regimens on preclinical activity on cell lines. A higher than expected response rate to the epidermal growth factor (EGFR) tyrosine kinase inhibitors gefitinib and erlotinib was recorded in BAC or in adenocarcinomas with BAC features compared with other NSCLC subtypes, mainly due to a higher rate of neversmoking patients. In fact, these agents demonstrated activity in the first-line setting especially in patients harboring EGFR mutations. The role of molecular predictors of response and survival such as EGFR gene amplification or EGFR mutations is an open field of research in fine-tuning BAC management. New drugs are being tested in advanced BAC, while more prospective data must be collected on predictive and prognostic factors.

Metabolic vulnerability in tumours illuminated

“…With respect to the particular utility of 18 FBnTP in NSCLC, it is notable that histological classification of these tumours in humans so far requires invasive tissue sampling, usually from a single site that might not reflect the complexity across the entire tumour. This is important, because the distinction between adeno carcinoma and squamous cell carcinoma influences the choice of chemotherapy 10 . An imaging technique such as the one proposed by Momcilovic and colleagues might therefore help to guide therapeutic decision-making.…”