Rare Genetic Mutation Improves Survival Outcome for Some NSCLC Patients

Rare ALK mutation allows patients to live an average of 4 years with the disease controlled.

A non-small cell lung cancer (NSCLC) diagnosis that has metastasized to the brain is a serious matter, but Yale researchers have identified a subset of NSCLC patients with a rare genetic mutation who are living much longer than patients without the mutation.

Approximately 85% of all lung cancers are NSCLC, with 30 to 50% of patients developing metastatic cancer to the brain. Patients with this particular strains of the disease die within 7 months, typically.

However, a rare ALK mutation found in just 5% of NSCLC cases allows patients to live an average of 4 years, with the disease controlled in the brain nearly a year after initial treatment.

“This study is among the first to show that genetic information about tumors can guide decision making for the treatment of brain metastases,” said Kimberly Johung, MD, assistant professor of therapeutic radiology and lead author of the study. “Patients with the ALK mutation respond so well to targeted systemic treatments that the brain lesions actually become the driving prognostic factor in their treatment plan.”

Treatment approaches involve whole-brain radiation therapy, radiation for individual lesions, and surgery, most likely for a single metastasis.

Whole-brain radiation is oftentimes associated with severe cognitive effects and the use of radiation therapy for progression is common in this population of patients, so researchers suspect that patients with the ALK mutation would benefit from radiation focused on individual metastases.

“Since patients are living longer with systemic disease controlled, there is likely a benefit to intensifying treatment of their brain lesions. This is a significant change in strategy for this population,” Johung said.