Genetic Testing of Lung Tumors Leads to Better Therapies


Smarter cancer therapy. For more than a decade, as research has provided more and more data about the genetic underpinnings of various cancers, this has been the goal of investigators seeking to devise better treatments with fewer side effects. Rather than taking the approach of traditional cancer therapies, which attack all rapidly dividing cells, these new drugs target the specific genetic changes inside cancer cells.

Now a study from a multicenter consortium co-led by Memorial Sloan Kettering has found that driver mutations — genetic changes that directly induce cells to become cancerous or spur their malignant behavior — can be found in about two-thirds of patients with advanced lung adenocarcinomas. Furthermore, survival was increased for patients who were given drugs matched to specific driver mutations.

“Since the discovery of the first gene linked to lung cancers in 2003, Memorial Sloan Kettering has made the testing of genetic mutations in lung tumor specimens our mission,” says Mark G. Kris, the William and Joy Ruane Chair in Thoracic Oncology and one of the leaders of the new study. “It’s been a priority to do this for every person with lung cancer treated here.”

Memorial Sloan Kettering plans to offer even more expanded genetic screening to patients with all types of advanced cancers through our MSK-IMPACT™ panel, a joint effort of our Molecular Diagnostics Service and our newly launched Marie-Josée and Henry R. Kravis Center for Molecular Oncology.

Transforming Patient Care

The findings, published in the May 20 issue of the Journal of the American Medical Association , came from the Lung Cancer Mutation Consortium (LCMC), a group of more than a dozen US hospitals. The researchers looked at tumor samples from more than 1,000 patients with advanced adenocarcinomas, one of the most common types of lung cancer. All of the specimens were tested for at least one mutation and more than 700 were tested for ten mutations known to be drivers of lung cancers.

In 64 percent of patients tested for all ten target genes, the investigators were able to uncover a genetic driver. The most common mutations were those in genes called KRAS, EGFR, and ALK. Of these patients, 28 percent were given a therapy designed to target the mutation driving their individual cancers. The average survival of patients receiving a targeted drug was extended more than a year, from 2.4 years to 3.5 years.

“This testing is all about information, giving your doctor the information that can assist him or her in making the best choice for you, and providing that personalization of care,” Dr. Kris says. “This study shows that you can get useful information this way, and that it ultimately leads to a targeted therapy in more than a quarter of cases.”

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Memorial Sloan Kettering Leads the Way

“Lung cancers are the model for how to treat patients with targeted cancer therapies. We’ve been doing it since 2004,” Dr. Kris says. That year, Memorial Sloan Kettering’s Molecular Diagnostics Service, led by molecular pathologist Marc Ladanyi, developed a test — the first of its kind approved by the state of New York — to test our patients with lung cancers for the EGFR gene mutation. (Researchers here and at two institutions in Boston had discovered the mutation the previous year.)

Based on the EGFR test results, patients could be given the drug Iressa® (gefitinib) or Tarceva™ (erlotinib), both of which have been shown to target EGFR mutations.

Dr. Kris notes that Memorial Sloan Kettering’s testing capabilities have grown tremendously in the past decade. With its latest genetic testing assay, known as MSK-IMPACT, the institution can now simultaneously search across 341 cancer-related genes for mutations in every patient sample. Genomics researcher Michael Berger and Dr. Ladanyi led the development and clinical implementation of MSK-IMPACT.

There are already targeted therapies available for many of these 341 genetic changes, including drugs now in wide use and compounds in various stages of clinical trials.

The next step for the LCMC is to routinely identify more targets, such as RET, another lung cancer target with a matched therapy that is under study by Memorial Sloan Kettering investigators. Next-generation inhibitors of ALK and EGFR are being studied as well.

On a broader scale, Memorial Sloan Kettering physicians and scientists will continue to test all patients with advanced cancers to look for driver mutations, and to match those patients with the treatments that are most likely to provide a benefit.

“Being able to do this kind of genetic testing was a vision in 2003” shortly after the Human Genome Project was completed, Dr. Kris concludes. “In 2014, it’s become a reality, and this study is just one example of how this information can help us make better treatment choices for all people with cancers.”

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This study was funded by the National Cancer Institute under grant 1RC2CA148394-010.


Commenting is disabled for this blog post.

I was recentdly diagnosed with staste 4 lung cancer with the gene mutation l898r in exon 21. I am visiting your Hospital next week for possible greement in the use of Tarceva a tyrosine KINASE inhibitor. Both my oncologosits agree this may be the first step in treatment., do you concur with this visit?

David, we are not able to answer personal medical questions on our blog. When you visit MSK next week, the doctors and nurses that you meet with should be able to answer all the questions you have about your treatment. Thank you for your comment.

How can I order the MSK-IMPACT test?

Dear AJRen, in order to take advantage of this type of testing at Memorial Sloan Kettering you need to make an appointment with one of our specialists. To do so, please call our Physician Referral Service at 800-525-2225.

Thank you for your comment.

My mom is recently diagnosed with lung cancer. She lives in NJ and is an Asian woman, non-smoker. We are awaiting biopsy results. How long would it take for MSK to get back EGFR mutation results?

Dear Iana, we are sorry to hear about your mom. We would have results for the two main EGFR mutations within a week of receiving the material at Memorial Sloan Kettering.

Thank you for your comment.

We would also like to make it clear that we perform these tests on specimens from individuals pursuing care here at Memorial Sloan Kettering and that we are not a commercial testing laboratory. Thanks again for your question.

Do you provide Immunotherapy for non small cell lung cancer patients? If yes, do patients require to enroll in a trial?

Helen, we currently have one open trial evaluating immunotherapy for non-small cell lung cancer. You can find out more information about it here:

If you’d like to make an appointment to learn more about this or other treatments for non-small cell lung cancer available at MSK, you can call 800-525-2225 or go to for more information. Thank you for your comment.

Does MSK Cancer Center accept to analyze biopsy samples taken elsewhere? If so, I am looking for genome sequencing as related to Tumor Mutational Burden for a non-small cell lung cancer patient from Bosnia-Herzegovina. As a friend, I am examining if there are any possibilities for an indigent foreign cancer patient to obtain both diagnostic and curative treatment in a stage four of lung cancer at an affordable cost?

Dear Hajrudin, we’re sorry to hear about your friend’s diagnosis. We recommend that he or she reach out to International Center at [email protected] or 1-212-639-4900 to find out whether a records review or an analysis of tumor samples may be possible. You can learn more about becoming an international patient at Thank you for your comment.

If my father in law receives treatment at MSK and then needs to sometimes stay with me in Pennsylvania, are we able to be “prescribed” treatment from you but go to a PA facility for the chemo or radiation, then come back to NY for follow ups, etc?

Dear Carrie, we’re sorry to hear about your father-in-law’s diagnosis. If you would like to get more information about how treatment is coordinated, you can call our Patient Access Service at 800-525-2225. Thank you for your comment, and best wishes to you and your family.

My wife is diagnosed with stage 4 NSCLC. She has Mucinous Andenocarcenoma with KRAS mutations metastatic to her spine. We are told there is no specific chemotherapy drug for this mutation. She is currently on 3 week maintenance of permatrexed and keytruda and thankfully her spine tumor has receded. Does MSK have any new potential drugs or treatment for this cancer type that would make it worth while for us to visit MSK. We live in MN and the travel would be difficult but neccessary if MSK has treatment.
Jack Park

Dear Jack, we’re very sorry to hear about your wife’s diagnosis. If you would like to speak to someone at MSK about what would be involved in coming here and potential treatment options, you can call 800-525-2225. If you are not able to travel to New York, we recommend that you seek out a National Cancer Institute-designated cancer center that is closer to where you live. There are two in Minnesota. You can find a complete list here. Thank you for your comment and best wishes to both of you.