Characteristics of lung cancers harboring NRAS mutations.

Ohashi K, Sequist LV, Arcila ME, Lovly CM, Chen X, Rudin CM, Moran T, Camidge DR, Vnencak-Jones CL, Berry L, Pan Y, Sasaki H, Engelman JA, Garon EB, Dubinett SM, Franklin WA, Riely GJ, Sos ML, Kris MG, Dias-Santagata D, Ladanyi M, Bunn PA, Pao W
Clin Cancer Res. 2013 19 (9): 2584-91

PMID: 23515407 · PMCID: PMC3643999 · DOI:10.1158/1078-0432.CCR-12-3173

PURPOSE - We sought to determine the frequency and clinical characteristics of patients with lung cancer harboring NRAS mutations. We used preclinical models to identify targeted therapies likely to be of benefit against NRAS-mutant lung cancer cells.

EXPERIMENTAL DESIGN - We reviewed clinical data from patients whose lung cancers were identified at six institutions or reported in the Catalogue of Somatic Mutations in Cancer (COSMIC) to harbor NRAS mutations. Six NRAS-mutant cell lines were screened for sensitivity against inhibitors of multiple kinases (i.e., EGFR, ALK, MET, IGF-1R, BRAF, PI3K, and MEK).

RESULTS - Among 4,562 patients with lung cancers tested, NRAS mutations were present in 30 (0.7%; 95% confidence interval, 0.45%-0.94%); 28 of these had no other driver mutations. 83% had adenocarcinoma histology with no significant differences in gender. While 95% of patients were former or current smokers, smoking-related G:C>T:A transversions were significantly less frequent in NRAS-mutated lung tumors than KRAS-mutant non-small cell lung cancer [NSCLC; NRAS: 13% (4/30), KRAS: 66% (1772/2733), P < 0.00000001]. Five of 6 NRAS-mutant cell lines were sensitive to the MEK inhibitors, selumetinib and trametinib, but not to other inhibitors tested.

CONCLUSION - NRAS mutations define a distinct subset of lung cancers (∼1%) with potential sensitivity to MEK inhibitors. Although NRAS mutations are more common in current/former smokers, the types of mutations are not those classically associated with smoking.

©2013 AACR.

MeSH Terms (25)

Adenocarcinoma Adult Aged Aged, 80 and over Antineoplastic Agents Benzimidazoles Cell Line, Tumor DNA Mutational Analysis Female Gene Frequency Genetic Association Studies GTP Phosphohydrolases Humans Inhibitory Concentration 50 Lung Neoplasms Male Membrane Proteins Middle Aged Mutation, Missense Protein Kinase Inhibitors Proto-Oncogene Proteins Proto-Oncogene Proteins p21(ras) Pyridones Pyrimidinones ras Proteins

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