Lung Cancer in Women
LC treatment paradigms with regard to surgery, radiotherapy, and cytotoxic chemotherapy do not vary with sex, whether for small cell, squamous cell, or the relatively rare large cell carcinomas. Sex differences appear in the treatment of bulky locally advanced and metastatic adenocarcinoma for which women are more likely than men to receive molecularly targeted therapy.
Multiple studies since 2007 have further elucidated the frequency of activating mutations and their association with clinical factors. An analysis of 2142 adenocarcinoma tissue specimens further supported previous evidence that activating EGFR mutations are more prevalent in women than men, with 26% of samples from women but only 19% of samples from men harboring the mutations (P < 0.001). It remains uncertain whether the increased but still low prevalence of activating mutations in women is caused by hormonal differences, differences in smoking patterns between women and men, a combination of these two factors, or other yet unidentified variables.
Subsequent to the discovery of EGFR as a potential therapeutic target, investigators identified another biomarker in lung adenocarcinoma, the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion protein, formed via gene rearrangement. Despite its increased prevalence in the tumors of never-smokers, this protein, which is highly susceptible to the TKI crizotinib, appears to have decreased prevalence among women.
Treatment
LC treatment paradigms with regard to surgery, radiotherapy, and cytotoxic chemotherapy do not vary with sex, whether for small cell, squamous cell, or the relatively rare large cell carcinomas. Sex differences appear in the treatment of bulky locally advanced and metastatic adenocarcinoma for which women are more likely than men to receive molecularly targeted therapy.
Multiple studies since 2007 have further elucidated the frequency of activating mutations and their association with clinical factors. An analysis of 2142 adenocarcinoma tissue specimens further supported previous evidence that activating EGFR mutations are more prevalent in women than men, with 26% of samples from women but only 19% of samples from men harboring the mutations (P < 0.001). It remains uncertain whether the increased but still low prevalence of activating mutations in women is caused by hormonal differences, differences in smoking patterns between women and men, a combination of these two factors, or other yet unidentified variables.
Subsequent to the discovery of EGFR as a potential therapeutic target, investigators identified another biomarker in lung adenocarcinoma, the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion protein, formed via gene rearrangement. Despite its increased prevalence in the tumors of never-smokers, this protein, which is highly susceptible to the TKI crizotinib, appears to have decreased prevalence among women.
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