Dr Aredo on the Molecular Distribution of Screening-Eligible Patients With NSCLC

Jacqueline Aredo, MD, MS, medical resident, University of California, San Francisco School of Medicine, discusses findings from a study assessing the molecular distribution of driver mutations and tumor suppressor gene mutations in patients with non–small cell lung cancer who are eligible for lung cancer screening, which she presented at the 2023 IASLC World Conference on Lung Cancer.

This study, which was conducted at Stanford Cancer Institute from 2008 to 2022, evaluated the proportion of patients who are eligible for lung cancer screening per the 2013 and 2021 United States Preventive Services Task Force (USPSTF) Lung Cancer Screening Guidelines whose tumors harbor molecular driver alterations. The 2013 USPSTF guidelines define eligible patients as those aged 55 to 80 years old who have a smoking history of at least 30 packs per year and currently smoke or have quit within the past 15 years. The 2021 USPSTF guidelines define eligible patients as those aged 50 to 80 years old who have with a smoking history of at least 20 packs per year and currently smoke or have quit within the past 15 years.

Among the 580 patients enrolled in the study, 26.4% (n = 153) met the 2013 USPSTF criteria and 36.7% (n = 213) met the 2021 USPSTF criteria. Patients who were eligible for screening per the USPSTF 2021 criteria had significantly fewer driver mutations than those who were not eligible for screening per these criteria. This study defined driver mutations as alterations with available targeted therapies, including EGFR, ALK, ROS1, RET, BRAF, ERBB2, KRAS, and MET exon 14. Of the patients who met the 2021 USPSTF criteria, 38.0%, 7.0%, 6.1%, 1.4%, 0.5%, 0.5%, 0.5%, and 0.0% had mutations in KRAS, BRAF, EGFR, MET exon 14, ALK, RET, ERBB2, and ROS1, respectively. Conversely, the incidence of mutations in the tumor suppressor genes TP53, STK11, and KEAP1 was significantly higher in patients who were eligible for screening compared with those who were ineligible, Aredo concludes.