Bronchogenic carcinoma and its prognostic and predictive factors

Bronchogenic carcinoma is one of the most common tumours and one with a very poor prognosis. Despite significant advances in diagnosis

and treatment, therapeutic outcomes have improved only slowly. Gradually, the proportion of morphologically confirmed neoplasms

has increased as has the proportion of oncological patients.

Both prognostic and predictive factors are used in making decisions about the treatment of such morphologically, clinically as well as

genetically heterogeneous group of disease.

The authors present the data on these factors, with a focus on selecting chemotherapy and biologically targeted therapy.

One of the predictors of chemotherapy efficacy is the histological type of tumour; nonsquamous carcinomas respond better to pemetrexed

while squamous ones to docetaxel. Expression of genes responsible for DNA repair and of ribonucleotide reductase allows to predict the

likelihood of efficacy of gemcitabin and cisplatin combination; thymidylate synthetase is a probable predictor of pemetrexed efficacy.

The efficacy of biologically targeted agents – tyrosine kinase inhibitors, gefitinib, and erlotinib, is directly related to the presence of

EGFR gene mutations and also likely related to copy amplification of this gene. Resistance to this therapy also has a predictor – the

T790M mutation in exon 20.

A treatment strategy primarily based on the use of predictive factors gradually results in improved therapeutic outcomes even in a disease

as serious as bronchogenic carcinoma.

Keywords: bronchogenic carcinoma, histological types, gene expression, EGFR gene mutations, chemotherapy, biologically targeted therapy.