|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 802-803
Authors' reply to Verma et al., Gupta et al., and Baa et al.
Akhil Kapoor1, Amit Kumar2, Kumar Prabhash3
1 Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, Uttar Pradesh, India
2 Department of Medical Oncology, Jayprabha Medanta Super Speciality Hospital, Patna, Bihar, India
3 Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
|Date of Submission||14-Nov-2021|
|Date of Decision||23-Nov-2021|
|Date of Acceptance||27-Nov-2021|
|Date of Web Publication||29-Dec-2021|
OPD 28, Mahamana Pandit Madan Malviya Cancer Hospital, Sunderpur, Varanasi, 221 005, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kapoor A, Kumar A, Prabhash K. Authors' reply to Verma et al., Gupta et al., and Baa et al. Cancer Res Stat Treat 2021;4:802-3
We would like to thank Verma et al., Gupta et al., and Baa and Malik for their interest in our article titled, “Concurrent EGFR and PIK3CA mutations in non-small-cell lung cancer,” published in the last issue of, Cancer Research, Statistics, and Treatment. We agree with the comments of Verma et al. that multi-gene next-generation sequencing (NGS) should be the norm and considered upfront in all patients. This is also recommended in the Indian consensus statement guidelines by Prabhash et al. However, the ground reality of the real world remains that NGS is used in <5% of patients with lung cancer in India. Even in the Western world, the use of NGS upfront remains <50%, as reported by a study presented at the American Society of Clinical Oncology, 2021 annual meeting. Hopefully, with the gradual reduction in the cost of NGS and availability of testing at more and more centers, the use of NGS upfront at baseline will improve and help guide further treatment. However, merely performing NGS is not enough; the interpretation of its results and discussion of all relevant therapeutic options best suited for an individual patient require the efforts of a dedicated molecular tumor board (MTB).
We thank Gupta et al. for bringing out additional important points in relation to EGFR and PIK3CA co-mutations. In fact, their letter echoes the basic theme of our article that there are significant lacunae in our current knowledge in deciding the management of patients with this mutational profile.
The cBioportal analysis and Oncoprint plot highlighted by Baa et al. add to our knowledge of PIK3CA mutation in lung cancer and are much appreciated. The high tumor mutation burden noted in this subgroup should be considered in making clinical decisions, and we completely agree with the comment that immunotherapy should be the preferred choice over alpelisib alone in these patients. In fact, as recommended by our institutional MTB, alpelisib was planned to be considered when all the standard options of treatment, including immunotherapy, were exhausted in view of the limited literature supporting the use of alpelisib in lung cancer. It is highly desirable to form a national group to record such cases and the outcomes along with the interventions offered. Moreover, it is important to have MTB discussions, which should go beyond a single institution. Hopefully, this will add to our understanding of difficult scenarios and will gradually lead to improvement in outcomes of our patients, which remains our ultimate goal.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Verma A, Disel U, Kaur J. Concurrent PIK3CA
mutation: A cause for primary resistance to epidermal growth factor receptor tyrosine kinase inhibitors or an acquired phenomenon? Cancer Res Stat Treat 2021;4:800-2. [Full text]
Gupta P, Bal A, Singh N. Comprehensive genomic profiling of lung cancer: A key to better clinical management. Cancer Res Stat Treat 2021;4:799-800. [Full text]
Baa AK, Malik PS. PIK3CA
alterations in non-small cell lung carcinoma: A puzzle yet to be solved. Cancer Res Stat Treat 2021;797-9.
Kapoor A, Noronha V, Shetty OA, Kashyap L, Kumar A, Chandrani P, et al.
Concurrent EGFR and PIK3CA mutations in non-small-cell lung cancer. Cancer Res Stat Treat 2021;4:541-6. [Full text]
Prabhash K, Vora A, Limaye S, Sahoo TP, Batra U, Patil S, et al.
Treatment of advanced non-small-cell lung cancer: First line, maintenance, and second line – Indian consensus statement update (Under the aegis of Lung Cancer Consortium Asia, Indian Cooperative Oncology Network, Indian Society of Medical and Pediatric Oncology, Molecular Oncology Society, and Association of Physicians of India). Cancer Res Stat Treat 2021;4:279-314. [Full text]
Robert NJ, Nwokeji ED, Espirito JL, Chen L, Karhade M, Evangelist MC, et al.
Biomarker tissue journey among patients (pts) with untreated metastatic non-small cell lung cancer (metastatic NSCLC) in the U.S. Oncology Network community practices. J Clin Oncol 2021;39 Suppl 15:9004.