Multi-institutional Oncogenic Driver Mutation Analysis in Lung Adenocarcinoma: The Lung Cancer Mutation Consortium Experience.
BACKGROUND
Molecular genetic analyses of lung adenocarcinoma have recently become standard of care for treatment selection. The Lung Cancer Mutation Consortium was formed to enable collaborative multi-institutional analyses of 10 potential oncogenic driver mutations. Technical aspects of testing and clinicopathologic correlations are presented.


METHODS
Mutation testing in at least one of the eight genes (epidermal growth factor receptor [EGFR], KRAS, ERBB2, AKT1, BRAF, MEK1, NRAS, and PIK3CA) using SNaPshot, mass spectrometry, Sanger sequencing+/- peptide nucleic acid and/or sizing assays, along with anaplastic lymphoma kinase (ALK) and/or MET fluorescence in situ hybridization, were performed in six labs on 1007 patients from 14 institutions.


RESULTS
In all, 1007 specimens had mutation analysis performed, and 733 specimens had all 10 genes analyzed. Mutation identification rates did not vary by analytic method. Biopsy and cytology specimens were inadequate for testing in 26% and 35% of cases compared with 5% of surgical specimens. Among the 1007 cases with mutation analysis performed, EGFR, KRAS, ALK, and ERBB2 alterations were detected in 22%, 25%, 8.5%, and 2.4% of cases, respectively. EGFR mutations were highly associated with female sex, Asian race, and never-smoking status; and less strongly associated with stage IV disease, presence of bone metastases, and absence of adrenal metastases. ALK rearrangements were strongly associated with never-smoking status and more weakly associated with presence of liver metastases. ERBB2 mutations were strongly associated with Asian race and never-smoking status. Two mutations were seen in 2.7% of samples, all but one of which involved one or more of PIK3CA, ALK, or MET.


CONCLUSIONS
Multi-institutional molecular analysis across multiple platforms, sample types, and institutions can yield consistent results and novel clinicopathological observations.
Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
Lynette M
LM
Sholl
Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Dara L
DL
Aisner
Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Marileila
M
Varella-Garcia
Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
Lynne D
LD
Berry
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Dora
D
Dias-Santagata
Department of Translational Molecular Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Ignacio I
II
Wistuba
Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
Heidi
H
Chen
Department of Translational Molecular Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Junya
J
Fujimoto
Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Kelly
K
Kugler
Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Wilbur A
WA
Franklin
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
A John
AJ
Iafrate
Memorial Sloan Kettering Cancer Center, New York, New York.
Marc
M
Ladanyi
Memorial Sloan Kettering Cancer Center, New York, New York.
Mark G
MG
Kris
Department of Medicine, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.
Bruce E
BE
Johnson
Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Lung Cancer Mutation Consortium, University of Colorado Cancer Center, Aurora, Colorado.
Paul A
PA
Bunn
University of Texas Southwestern, Dallas, Texas.
John D
JD
Minna
Department of Medicine, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: dk@rics.bwh.harvard.edu.
David J
DJ
Kwiatkowski
D000230:Adenocarcinoma / Q000235:genetics* / Q000556:secondary; D000310:Adrenal Gland Neoplasms / Q000235:genetics* / Q000556:secondary; D000077548:Anaplastic Lymphoma Kinase; D001859:Bone Neoplasms / Q000235:genetics* / Q000556:secondary; D058534:Class I Phosphatidylinositol 3-Kinases; D003299:Cooperative Behavior; D004252:DNA Mutational Analysis / Q000379:methods / Q000592:standards; D005260:Female; D015321:Gene Rearrangement; D018773:Genes, erbB-1 / Q000235:genetics; D018734:Genes, erbB-2 / Q000235:genetics; D011905:Genes, ras / Q000235:genetics; D006801:Humans; D008113:Liver Neoplasms / Q000235:genetics* / Q000556:secondary; D008175:Lung Neoplasms / Q000235:genetics* / Q000473:pathology; D048369:MAP Kinase Kinase 1 / Q000235:genetics; D008297:Male; D009154:Mutation; D009367:Neoplasm Staging; D019869:Phosphatidylinositol 3-Kinases / Q000235:genetics; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D051057:Proto-Oncogene Proteins c-akt / Q000235:genetics; D019859:Proto-Oncogene Proteins c-met / Q000235:genetics; D044469:Racial Groups / Q000235:genetics; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics; D012737:Sex Factors; D012907:Smoking / Q000235:genetics
D000077548:Anaplastic Lymphoma Kinase; D058534:Class I Phosphatidylinositol 3-Kinases; D048369:MAP Kinase Kinase 1; D019869:Phosphatidylinositol 3-Kinases; D048493:Proto-Oncogene Proteins B-raf; D051057:Proto-Oncogene Proteins c-akt; D019859:Proto-Oncogene Proteins c-met; D020794:Receptor Protein-Tyrosine Kinases; C484760:PIK3CA protein, human; C000626173:ALK protein, human; C491743:MET protein, human