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African-American genetic mutations pose Rx challenge

African-American genetic mutations pose Rx challenge

A PET/CT fusion image
A PET/CT fusion image, frontal (coronal) section, showing non-small-cell lung cancer (NSCLC) of the right lung (on the left in this image). The large spot represents cancer of the lung at an advanced stage.

Lung cancer is not a discriminate disease, but the disease burden is especially high on African Americans in the U.S. The statistics are stark: African-American men are 37% more likely to develop lung cancer than white men and are 22% more likely to die of it. In addition, only 12% of African Americans live longer than five years after a diagnosis of lung cancer, compared with 16% of whites, according to a recent report by the American Lung Association (see Fact box).

One suggested reason for this gap in outcomes is differences in race-based genetics. In the era of personalized medicine and treatments that target specific disease pathways, identifying genetic differences among populations is becoming increasingly important to optimize benefit.

In lung cancer, it is well established that patients with non-small-cell lung cancer (NSCLC) who harbor the epidermal growth factor receptor (EGFR) gene mutation benefit from the targeted therapies erlotinib (Tarceva) and gefitinib (Iressa).

FACT
ALA report
"Too Many Cases, Too Many Deaths: Lung Cancer in African Americans," can be accessed at www.lungusa.org/about-us/our-impact/top-stories/african-americans-and-lung-cancer.html.
William J. Hicks, MD
"Differences in [lung cancer] treatment for African Americans are more important than the genetic differences."
— WILLIAM J. HICKS, MD

Data are mixed on the importance of EGFR mutations in the African-American population: Some research finds that the mutation is infrequent in African Americans while other data indicate no difference in the frequency of this mutation between African Americans and whites. Furthermore, how does genetic difference influence treatment? Oncology News International spoke with lung cancer experts on the current data on EGFR mutations in this population and the current therapeutic options.

"The whole emphasis on genetic analysis is in its infancy," said William J. Hicks, MD, one of the authors of the ALA report. "Certainly data are going to evolve, and we are going to modify our suggestions and approach based on that." Dr. Hicks is a professor of clinical medicine, division of hematology and oncology, at the Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus.

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