title: Mutation testing for directing upfront targeted therapy and post-progression combination therapy strategies in lung adenocarcinoma.
abstract: Advances in the biology of non-small-cell lung cancer, especially adenocarcinoma, reveal multiple molecular subtypes driving oncogenesis. Accordingly, individualized targeted therapeutics are based on mutational diagnostics.
  
  
  
  Advances in strategies and techniques for individualized treatment, particularly of adenocarcinoma, are described through literature review. Approved therapies are established for some molecular subsets, with new driver mutations emerging that represent increasing proportions of patients. Actionable mutations are de novo oncogenic drivers or acquired resistance mediators, and mutational profiling is important for directing therapy. Patients should be monitored for emerging actionable resistance mutations. Liquid biopsy and associated multiplex diagnostics will be important means to monitor patients during treatment. Expert commentary: Outcomes with targeted agents may be improved by integrating mutation screens during treatment to optimize subsequent therapy. In order for this to be translated into impactful patient benefit, appropriate platforms and strategies need to be optimized and then implemented universally.
authors.affiliation: a Department of Medical Oncology and Therapeutics Research , City of Hope , Duarte , CA , USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Salgia
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000235:genetics*; D004273:DNA, Neoplasm / Q000737:chemistry / Q000235:genetics; D004359:Drug Therapy, Combination; D005820:Genetic Testing / Q000379:methods*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D009154:Mutation; D017422:Sequence Analysis, DNA / Q000379:methods
chemical_list: D004273:DNA, Neoplasm
keywords: NSCLC; diagnostics; liquid biopsy; mutation; oncogenic drivers; re-biopsy; resistance