Lung Cancer Vignette

Question 1

1. Demonstrate the application of molecular biology into the clinic using lung cancer as an example.

Answer 1

look at Her2 and ALK example on other card.

Question 2

2. How to implement molecular targeted therapies in the treatment of (lung) cancer.

Answer 2

well it seems like you would do molecular profiling

see what mutation it is and then go from there..

Question 3

3. How to select patients in order to give the right treatment to the right patient (“Personalized medicine” or “Precision medicine”).

Answer 3

Personalized therapy based on tumor’s molecular characteristics will prolong survival multifold for specific subgroups of patients- with potential for “cure” in the future.
- The science btich:
HER2 receptor
activate the downstream signaling pathway for example EGFR which has many domains. The extracellular domain can be targeted with antibody.
-Targeting of the intracellular domain with a EGFR-TKI

-ALK is another molecular driver of lung cancer on chr 2
fusion of EML4 and ALK can be diagnosed by FISH or immunohistoc
use and ALK tyrosine kinase inhibitor

Question 4

4. Differentiate between prognostic and predictive biomarkers.

Answer 4

Examples of biomarkers for early detection:

• sputum
• serum/plasma
• exhaled breath

Question 5

5. Describe the status of lung cancer screening.

Answer 5

-Lung Cancer screening very encouraging: Reducing lung cancer mortality with 20% and all cause mortality with 7%
-screening high risk people (previous and current smokers in age of 55-74) with low dose CT
-Which is good because lung cancer in early stages can be cured.
-BUT! False positive rates: >90%:Need for “adjunct” biomarker!
no screening tolls for people who are not in this “high risk group’ like the female never smokers.