Finding

On Cancer: Testing for Mutations Identified in Squamous Cell Lung Cancer Tumors Helps Personalize Treatment

By Media Staff  |  Thursday, May 17, 2012
Pictured: Paul Paik Medical oncologist Paul Paik

Screening lung cancer tumor samples for cancer-causing, or “driver,” genetic mutations can help physicians tailor patients’ treatments to target those specific mutations. While scientists have identified cancer-causing mutations for the majority of lung adenocarcinomas — the most common type of non-small cell lung cancer — and have developed drugs that can successfully address them, scientists have not yet identified targeted therapies for another type of non-small cell lung cancer known as squamous cell carcinoma.

Now, researchers from Memorial Sloan Kettering Cancer Center have begun testing for three new genetic targets and found that together they occur in approximately 50 percent of patients with squamous cell carcinomas of the lung, which affects 40,000 Americans each year. Initial findings of the research will be presented on June 4 at the 2012 American Society of Clinical Oncology (ASCO) Annual Meeting.

“In the span of one year, we have gone from having essentially zero clinical trials of targeted therapies to offer our squamous cell lung cancer patients to being able to offer clinical trials of targeted therapies to upwards of 50 percent,” said Paul K. Paik, a medical oncologist on Memorial Sloan Kettering’s Thoracic Oncology Service and lead investigator of the new molecular testing project known as the Squamous Cell Carcinoma of the Lung Mutation Analysis Program, or SQ-MAP.

Memorial Sloan Kettering was one of the first centers to use this type of genetic testing for lung cancer patients and is currently one of the only centers testing for mutations in squamous cell carcinomas of the lung. Memorial Sloan Kettering is also one of only a handful of centers in the world that conducts genetic testing of the tumor as a routine part of diagnosis and staging for patients with non-small cell lung cancer.

Genetic testing of lung adenocarcinomas is conducted as part of the Lung Cancer Mutation Analysis Project (LC-MAP), which began at Memorial Sloan Kettering in January 2009. SQ-MAP, which began in October 2011, has already identified cancer-causing mutations in 50 percent of squamous cell lung carcinoma tumors tested. Enrollment is now open for two clinical trials of new targeted therapies for this type of cancer, and a third clinical trial is planned. 

Dr. Paik received a Conquer Cancer Foundation of ASCO Career Development Award and a Geoffrey Beene Grant Award for this project.

Comments

This was a very interesting article. My partner was diagnosed with lung cancer (squamous cell carcinoma and adenocarcinoma), which also spread to her liver. She has had chemo, radiation and the RFA procedure was done last week on her liver. We are still waiting on a biopsy result from caris on what chemo drugs to use to continue her battle with the lung. She is in a rest period now trying to get strong again to start chemo the first week of August. I have tried to get appointments at Sloan in Basking Ridge and the city before her next round of chemo, but have not been successful.

Joan, we will send you a private message on this topic.

Is there any further updates in regards to this article. We are located in Missouri and was wondering if this treatment was available near this region.

Dr. Paik has suggested that Washington University in St. Louis may have similar kinds of treatments for squamous cell lung cancer closer to where you live. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225. Thanks for your comment!

My 87yr. old grandmother whos lives in Harrisburg, Pa. was diagnosed in August 2011 with Squamous carcinomas Lung Cancer. She has undergone Cyber Knife Radiation Treatment almost 9 months ago. Recently her tumor has grown larger and now her Oncologist attempted to begin Radio Abrascion Therapy. But they feel she might be worst off afterwards. Can you suggest another treatment or Cancer Center closer to her home that we can contact?

Thank you for reaching out. We would recommend that you review the list of National Cancer Institute-designated cancer centers here: http://www.cancer.gov/researchandfunding/extramural/cancercenters. If you would like to make an appointment at Memorial Sloan-Kettering, please contact our Physician Referral Service at 800-525-2225.

My wife, Judy was diagnosed with stage 3b lung cancer, squamous cell. She has received chemo and radiation for 8 weeks. Pet scan Nov. 29, 2012 with results to follow. She, I , nor any of our families have ever smoked. She has never worked in a smoked environment. She is 58 years old and was in good health. During the chemo of Carbuplatin and Taxol her blood counts remained very good. Hair loss minamal. She had two suspected lymph nodes removed. Came back negative. We hope to hear the words on Dec. 11 cancer free. No matter what the outcome, Would she still be a candidate to date for any of your newly formed clinical trials? We are looking for HOPE.
Thank you
Ron Hathorn

Thank you for your comment. Unfortunately, we can't provide specific medical information on our blog. You would need to consult with one of our physicians who could evaluate whether your wife is a clinical trial candidate. If you are interested in making an appointment with one of our doctors, please call 800-525-2225.

I was diagnosed 2 days ago with mixed adno-squamous cancer. Age 42, zero risk factors. I live in the Chicago area. Do you know of any organizations in this area which do the same generic testing you referred to in the article?
Any info you can supply would be most appreciated! Thanks!

We encourage you to reach out to a local physician to discuss options for this type of genetic testing in your area. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call 800-525-2225.

Sorry... Typing on a smart phone... I meant "genetic" testing. Thanks!

Hi! I live in Naples, Italy and was diagnosed with squamous cell lung cancer - stage 3 - a year ago yesterday. I have done carboplatinum/gemcitabine, had 30 radiation sessions and tomorrow I will start 2nd line of chemo - taxotere. There has been no progression nor shrinkage so far - no mets either. I would like to know of this trial is being done together with the Max Planch Institute/Univ. Of Cologne in Germany or in any other European location that I would be able to travel to. Or perhaps, if I have the qualifications, if I would be able to partecipate "remotely" with the help of my oncologist.
Thank you for your kind answer.
Best regards,
Darby Mudsno

Thank you for reaching out. Dr. Paik notes that while Memorial Sloan-Kettering does not collaborate with other institutions in regard to genetic testing, multiple centers in Europe are running clinical trials of targeted therapies for squamous cell lung cancer. He says that you might try contacting Dr. Jürgen Wolf at the University of Cologne in Germany for information about testing and potential local trials.

Where can I find info. that a lay person can understand, about Cyber-Radiation? It's been reccommended to her , post breast cancer surgery.This was the first time hearing of this procedure. She has turned to me , as a retired R.N. , but I'm clueless. Is this procedure offered at MSKCC?
Thank you for any information you can provide.

Thanks for your comment Leona! This video provides a general description of Cyber Knife radiation. For more specific information on radiation therapy for breast cancer, this page includes information on a computer-guided approach, available at Memorial Sloan-Kettering, called IMRT.

Hi, my dad was diagnosed with non small cell (squamous cell) in April of this year. He had 4 treatments of carbo/taxol and had a great response with that. He had lower back pain for a symptom which lead him to go to his doctor and that led to the diagnosis. Aug. 3rd 2012 he had his last chemo treatment and was no longer in pain. His pet scan showed 90% shrinkage of lower lobe tumor. He was then put on Tarceva but had too go off it twice (one week each time) for side effects. His pain is back in the same spot as it was before and will have a ct scan on Dec 5th. My question is, he is 71 yrs old, stage IV...would he be a candidate for this trial and would he have to come to NY or could this be done here in Maine?

Thank you for your comment. Unfortunately, we can't answer personal medical questions on our blog. This includes evaluating clinical trial eligibility for particular patients. If you would like to make an appointment with one of our doctors, please call 800-525-2225.

Hi,
What wonderful research Dr. Paik. What drugs and drug companies are involved in your trials? Is there any testing that my doctor can do to identify if I am in the 50% that might benefit by calling you to see about trial participation?
Thanks,
Sharon

Thanks for your comment! Dr. Paik says that there are three key trials at Memorial Sloan-Kettering fueled by which marker is present. The first includes a drug called AZD4547 (AstraZeneca), the second uses a drug called BKM120 (Novartis), and the third uses an FDA-approved drug for leukemia called dasatinib (BMS).

Your doctor can send a tumor sample, if there is enough, to Foundation Medicine, a company in Boston that performs testing for the common targets in all non-small cell lung cancers, including squamous cell cancers. From there, your doctor should be able to guide you to a center that has an appropriate trial. If you live within 1.5 hours of Memorial Sloan-Kettering by car, then we can perform the testing here as well. We can't perform the testing for patients who cannot practically come to participate in early phase studies, as the testing and the studies are linked.

My father in law was detected squamous cell carcinoma in apical segment of left lower lobe encasing branches of left inferior pulmonary artery. The lesion encases segmental bronchus of left lower lobe. on 31-3-2012
Treatment
CA LUNG SQ CELL CA STAGE III A
CISPLATIN WEAKLY WITH RT
POST CT - RT
BX POSITIVE FROM RESIDUAL
6 CYCLE PACLITAXEL + CARBOPLATIN
completed on 24/1/2013
No significant change has been observed
in ct scan or pet
condition of patient stable
Question
1. Any further treatment like targeted therapy possible
2. How will TAB EVOLITINIB (150) help in this case
3. What are its side effect
4. Can you suggest some other Related Tab which can be more effective in this case

Thank you for your comment. Unfortunately, we cannot answer personal medical questions on our blog. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call 800-525-2225.

Hi, I am from Macau, China. It's great to read about this exciting development of treatment for Squamous Cell lung cancer. My husband was diagnosed with Squamous Cell carcinoma stage 3 about 4 mouths ago. He has since gone through 22 sessions of radiotherapy and 4 session of chemo (Taxel-carboplatine). We are expected to have a CT scan in about a month to see result and to determine next line of treatment. Dr. Paik, do you know of any medical institutes in Asia that are conducting similar trial? Thank you so much for your help!

We spoke with Dr. Paik, who says that he is unaware of any center that is conducting a similar kind of molecular testing study. However, the closest contact for you would be Dr. Tony Mok at the Chinese University of Hong Kong in Prince of Wales Hospital, who may have trials going on.

I had the University of Iowa Hospitals & Clinics overnight Federal Express my slides & Path Report to Dr. William Travis, Dep't of Pathology, there at MSKCC. The path report that was read here is calling my 4.1 cm upper right lung lobe tumor: poorly differentiated NSCLC with basaloid squamous LC. (a rare type of squamous cancer).

I am being recommended Taxol/Carbo - 4 rounds, but I want to make sure this is the right treatment plan. I am wondering if your path dep't will concur with the U of I's findings. I may explore the possibility of coming out there for TX if you think need be. Thank you.
Mary in Iowa

If you'd like information about making an appointment at Memorial Sloan-Kettering, you can go to: http://www.mskcc.org/cancer-care/appointment or call 800-525-2225. Thanks for your comment.

I have just been diagnosed with Squamous cell. Its the size of plum and cant be operated on as it's to close to heart. I have had no treatment thus far. I was wondering if the Doctor would find working with me appealing. Please contact me if he would be interested. I live near Pittsburgh Pa. Thank you

Thank you for your comment. Please contact us to make an appointment with a doctor at Memorial Sloan-Kettering: 800-525-2225.

My Dad age 79 has being diagnosed with satge 3a Squamous NSCLC, at hilum and carina of right lung lymph nodes, with no metastic activity noted on Pet scan. So far we have being advised that surgary is not an option and are awaiting decision regarding treatment. Hx includes ex smoker by 3 yrs, GIST 3 yrs ago (sucessfully treated with mimilar local surgary and 1 year of Glevac), unfortunately GIST had locally returned, no treatment planned as focusing on lung cancer.
Q1 Are you aware of any trials in Ireland? Q2 Would targeted therapies help with squamous NSCLC? Thank you, Ann Ireland
I wish you continued sucess with your work Dr Paik

Hi Ann, we spoke to Dr. Paik, who said, "For Stage IIIA squamous cell lung
cancer, the standard of care continues to be either a combination of
chemotherapy plus radiation or chemotherapy plus surgery. If a thoracic
surgeon has evaluated your father and deemed surgery inadvisable, then the
next step would be to meet with a radiation oncologist. We are fortunate
that clinical trials for our squamous cell lung cancer patients are now up
and running worldwide; however, none would supplant the standard-of-care
treatments for your father who, fortunately, has not had his cancer spread
outside of the lungs, from what you've written. I am unaware of any
centers in Ireland that are participating in squamous lung cancer specific
trials, unfortunately. Beatson Institute for Cancer Research is
participating in at least one squamous cell lung cancer-specific study,
which, while not in Ireland, may be able to direct you better toward
centers in Ireland." Thank you for your comment.

Dear MSK,
I am writing again with the hope that you might be able to give me the info I am looking for. I am am American woman who has lived in Italy for the past 30 years. I wrote to you back in Nov. 2012 asking for info about squamous LC trials in Europe. Dr. Paik referred me to Dr. Juergen Wolf at the University of Cologne. They have been wonderful with testing my samples for Fgfr1 (negative) and now DDR2 (ongoing). They have also assured me that if the testing is positive I can be enrolled in their trial. Thank you so much for showing me this path!
In the meantime, while waiting for the results, I have been reading about Pd1 trials. Do you know of any open in Europe or who I could contact ?
I am about to start my second cycle of third line chemo on Monday (have also had max radiation). I am desperately looking for future treatments.
Thank you for your time and consideration.
Darby Mudano

Darby, we sent your question to Dr. Paik and he provided this information about a study using the anti-PD1 drug which is open in Munich: "The CA209-063 lung study just opened up in Germany. Eberhard Buchner, the Hub Site Manager (cc’d) located in Munich, Germany with telephone number 49.89.12142.211 will be able to provide you with some additional information regarding access to the study over there. " Hope this information is useful for you. Good luck.
.

Hi. My father was just diagnosed with Basaloid variant of squamous cell carcinoma or possible basaloid carcinoma per his cytology report. KI-67 shows 80% proliferation. Positive for p63, ck5, cd56 & napsin-a. Negative for ttf-1, synaptophysin, chromogranin, s100 & lca. Dense right lobe, extensive bulky mediastinal lymph node enlargement, right hilar nodes and osseous destruction of the posterior 3rd rib. Are any of the trials at Memorial Sloan-Kettering open for his particular case? He has not started treatment yet, however tomorrow is a visit to oncologist and radiation oncologist.

Lori, you can find a list of our clinical trials for squamous cell lung cancer here: http://www.mskcc.org/cancer-care/clinical-trials/clinical-trial?keys=squamous+cell&field_trial_diseases_value=Lung+Cancer. If you would like to make an appointment with a Memorial Sloan-Kettering doctor, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

My father was diagnosis with squamous cell carcinoma cancer (tumor blocking the wind pipe) in January (near his voice box). My father and the doctors opted for him to have 35 treatments of the radiation and 10 treatments of Erbitux. They did not give him chemotherapy because he has a low kidney function and they didn't want him to lose his kidney ability. He is a diabetic that uses insulin, is hypertensive and had prostrate cancer in 2003 which was treated and cured by a seed plantation. Because his breathing was bad, he had a tracheotomy installed to help with his radiation and Erbitux treatments. I am pleased to say that his tumor near the voice box shrunk and the tracheotomy was recently removed. However, because he was not getting any nutrient (lost his ability to swallow), the doctors had to install a PEG tube inside him because his epiglottis was directing food into his lungs and was not going into the stomach properly. He had his Pet scan yesterday and we learned that liver metastases was discovered which is our main concern. The doctor says that he needs to have a liver biopsy but this could cause collapsing of the liver which completely concerns us. I need to know if you have a center in or near Austell Georgia. Do you have any doctor's at MSKCC that specialize in this type of cancer? Is there a clinical trail for him to participate in? Any assistance with this would be appreciated. Thank you.

Kay, you can read more about our approach to treating head and neck cancers here: http://www.mskcc.org/cancer-care/adult/head-neck. If your father would like to make an appointment to meet with a Memorial Sloan-Kettering physician in the New York City area, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. To find a list of other National Cancer Institute-designated cancer centers, including some that are closer to your home in Georgia, you can go to http://www.cancer.gov/researchandfunding/extramural/cancercenters/find-a-cancer-center. Thank you for your comment.

We live in Vancouver, BC, Canada. My husband has been diagnosed with stage IV lung cancer last year and has progressed. He received 25 radiation treatments in Dec 2012 and 4 rounds of 1st line chemo, carboplatin and gemcitabine. He is now on to the 2nd line chemo, Taxotere every 3 weeks, another 3 treatments scheduled. His tumour is 6.7 cm and spread to his rib bone.
Please advise what treatments/clinical trials are available for him. We are open to any recommendations and are willing to travel after his treatments finished.

If you would like to learn more about coming to Memorial Sloan-Kettering from outside the US, please contact our International Center at http://www.mskcc.org/cancer-care/international-patients. They can also tell you how to arrange a records review. To learn about clinical trials at Memorial Sloan-Kettering for lung cancer, you can go to http://www.mskcc.org/cancer-care/clinical-trials/clinical-trial?keys=&field_trial_diseases_value=Lung+Cancer. Thank you for your comment.

My husband was diagnosed with squamous cell carcinoma cancer in the vocal cord and had radiation . He did well for 2 years then it popped up 2 months after a check up in the lungs as a stage IV. We were so diligent about check ups. He is now doing chemo to shrink the nodules in the lungs. They want to do a ct before # 3 infusion. He had a ct scan 10 months before nothing was there. Are there any trials like Dr. Paik's research in Virginia or a near by state . I would really love to know. Your comment would be so appreciated! thanks

Jude, to find clinical trials in your area, we recommend you go to the National Institutes of Health's clinical trials database at http://clinicaltrials.gov/. If you would like to make an appointment to speak with a doctor at Memorial Sloan-Kettering about treatment or a second opinion, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

Good Day MSK Team! I would like to ask if you ever help undergraduate researchers for this kind of study?
I'm from the Philippines. I would really appreciate if I could get some information from Dr. Paik; also here in the Philippines that if you could refer some physicians that could help me go through my research regarding Lung Cancer. I would gladly be open to accept criticisms on my research in finding ways to prevent (before it becomes benign or malignant or even before it spreads in different parts of the body) or to have a cure on Lung Cancer. Thank you so much for your kind reply.

Hi, Dylan. We have a lot of information about lung cancer on our website, so we recommend you start there, http://www.mskcc.org/cancer-care/adult/lung. The US National Cancer Institute is another good source of information. You can find their information about lung cancer at http://www.cancer.gov/cancertopics/types/lung. Good luck with your project.

what are the specific genes tested for in this article? Thank you.

Hi Evon, the genes tested for in this study for which there are actionable trials for squamous cell disease were FGFR1, DDR2, PIK3CA, PTEN, and KRAS. There were another 270 or so genes also included. Thank you for your comment.

My father was diagnosed with poorly differentiated squamous cell carcinoma of the lung last week. He lives in Jacksonville, FL and is treated at University of Florida Shands (Jacksonville). Could you tell me, where could we do molecular signature genetic test in the area in an attempt to identify cancer causing mutations. A bronchoscopy was performed on him and tissue has been extracted from two of the lymph nodes that the cancer has spread to. Also, are there other tests that could be done for poorly differentiated squamous cell carcinoma (other than the histopathology and genetic testing for driver mutations)? Thank you!

Betty, we recommend you start by checking the National Cancer Institute's list of designated cancer centers to find one in your area. You can find the list at http://www.cancer.gov/researchandfunding/extramural/cancercenters/find-a-cancer-center. Once you get in touch with the one that is best for you geographically, they'll be able to tell you what kind of tests they offer. If you'd like to speak with a doctor at Memorial Sloan-Kettering about treatment or a second opinion, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

My husband has non-small cell squeamish carcinoma on right lung. The cancer mass has collapsed the windpipe to upper right lobe. The cancer has not spread to other parts of his body.
He is 77 years old, nonsmoker. In general good health.
He went through a chemo-radiation combo treatment from 3-17-2013 to 4-18-2013.
This included 6 weeks of daily radiation and weekly chemotherapy with taxol-carboplatnin.
Chemo was done before radiation treatment of the day.
On July 18, 2013, his PET scan showed that his glucose uptake have dropped from 16 to 6.3. The 6.3 uptake was stated as significant.
He can now breathe normally. His windpipe is no longer collapsed by the cancer mass. Lately, he has some dry coughs.
His Oncologist asked us to do another PET scan three months after July 18. Nothing will be done in the meantime.
But we worry if the 6.3 glucose uptake was from remaining life cancer Cells and three months wait may allow them to grow back to cancer mass.
What is the cause of the 6.3 glucose uptake?
Our insurance is Kaiser Permanente and Medicare.
Can you help us, we can travel to visit you.
Thank you very much, and we appreciated your response.

Nora, If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

EVA LEE,We live in Vancouver, BC, Canada. My husband has been diagnosed with stage IV lung cancer last year and has progressed. He received 25 radiation treatments in Dec 2012 and 4 rounds of 1st line chemo, carboplatin and gemcitabine. He is now on to the 2nd line chemo, Taxotere every 3 weeks, another 3 treatments scheduled. His tumour is 6.7 cm and spread to his rib bone. Please advise what treatments/clinical trials are available for him. We are open to any recommendations and are willing to travel after his treatments finished...

EVALEE, my Dad who is aged 72 , diagonised for Stage 4 fr squamous cell and we started with Round GEMCARBO similiar too...even I'm looking for pointers towards clinical trials , though we will continue on his first line of treatment..Please share your experience

If you would like to learn more about coming to Memorial Sloan-Kettering from outside the US, please contact our International Center at http://www.mskcc.org/cancer-care/international-patients. They can also tell you how to arrange a records review. To learn about clinical trials at Memorial Sloan-Kettering for lung cancer, you can go to http://www.mskcc.org/cancer-care/clinical-trials/clinical-trial?keys=&field_trial_diseases_value=Lung+Cancer. Thank you for your comment.

MY 73 y/o brother was just diagnosed with stage 4 BASALOID SQUAMOS CELL CARCINOMA. Primary site larynx with mets to gallbladder and abdominal/peritoneal lymph nodes. we are told this is extremely rare. his chemo doc needs to do research to find correct mode of treatment. have you seen this cancer?we need to help him CORRECTLY!

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