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A Brief Report of Transformation From NSCLC to SCLC: Molecular and Therapeutic Characteristics
Léonie Ferrer1, Matteo Giaj Levra2, Marie Brevet3
1Thoracic Oncology unit, PTV, CHU Grenoble CS10217-38043 Grenoble cedex 9, France et INSERM U 823.
Introduction:
Histologic transformation from NSCLC to SCLC is a mechanism of resistance in EGFR-mutant tumors but is also occasionally observed in nonmutated NSCLC.
Methods:
We performed a multicenter retrospective collection of cases presenting between 2005 and 2017. The objectives were to analyze survival data and to define epidemiologic, clinical, treatment and histomolecular characteristics at both the time of diagnosis of NSCLC and of SCLC.
Results:
Forty-eight EGFR-mutant NSCLC and 13 non-EGFR-mutant cases were registered. Most EGFR-mutant tumors retained the same EGFR mutation after transformation. The median time to SCLC transformation was shorter in the EGFR-mutant group than in non-EFGR mutants (16 months versus 26 months (p = 0.01)). Both tumors were responsive to platinum etoposide regimens (45% partial response for the EGFR-mutant group versus 40% for non-EFGR mutants). The median overall survival rates were 28 months in the EGFR-mutant group versus 37 months in the non-EFGR-mutant group, respectively. After transformation, the median overall survival was 9 months in the non-EGFR-mutant group versus 10 months in the EGFR-mutant group.
Conclusions:
Transformation into SCLC seems to occur more quickly in EGFR mutated tumors; however, once the tumor is transformed its survival and response to treatment seems comparable to that of classical SCLC.
Insights
Histologic transformation from non-small cell lung cancer (NSCLC) to small cell lung cancer (SCLC) occurs faster in EGFR-mutant tumors. However, transformed tumors show similar survival and treatment response to classical SCLC.
Area of Science:
- Oncology
- Molecular Biology
- Cancer Research
Background:
- Histologic transformation from non-small cell lung cancer (NSCLC) to small cell lung cancer (SCLC) is a known resistance mechanism in EGFR-mutant lung tumors.
- This transformation can also occur in NSCLC without EGFR mutations.
Purpose of the Study:
- To analyze survival data in patients with NSCLC transforming to SCLC.
- To define epidemiologic, clinical, treatment, and histomolecular characteristics of this transformation.
- To compare outcomes between EGFR-mutant and non-EGFR-mutant NSCLC cases undergoing transformation.
Main Methods:
- Multicenter retrospective case collection from 2005 to 2017.
- Analysis of epidemiologic, clinical, treatment, and histomolecular features.
- Comparison of survival data between EGFR-mutant and non-EGFR-mutant groups.
Main Results:
- Forty-eight EGFR-mutant and 13 non-EGFR-mutant NSCLC cases with SCLC transformation were identified.
- The median time to SCLC transformation was significantly shorter in EGFR-mutant tumors (16 months vs. 26 months).
- Both groups showed similar response rates (45% vs. 40% partial response) to platinum-etoposide and comparable post-transformation overall survival (9-10 months).
Conclusions:
- EGFR-mutated NSCLC tumors appear to transform into SCLC more rapidly.
- Once transformed, the SCLC exhibits survival and treatment response characteristics similar to classical SCLC.
- The findings highlight a distinct transformation dynamic in EGFR-mutant lung cancer.
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