Progress in genome-inspired treatment decisions for multifocal lung adenocarcinoma

ABSTRACT

Introduction

Multifocal lung adenocarcinoma (MFLA) is becoming increasingly recognized as a distinct subset of lung cancer, with unique biology, disease course, and treatment outcomes. While definitions remain controversial, MFLA is characterized by the development and concurrent presence of multiple independent (non-metastatic) lesions on the lung adenocarcinoma spectrum. Disease progression typically follows an indolent course measured in years, with a lower propensity for nodal and distant metastases than other more common forms of non-small cell lung cancer.

Areas covered

Traditional imaging and histopathological analyses of tumor biopsies are frequently unable to fully characterize the disease, prompting interest in molecular diagnosis. We highlight some of the key questions in the field, including accurate definitions to identify and stage MLFA, molecular tests to stratify patients and treatment decisions, and the lack of clinical trial data to delineate best management for this poorly understood subset of lung cancer patients. We review the existing literature and progress toward a genomic diagnosis for this unique disease entity.

Expert opinion

Multifocal lung adenocarcinoma behaves differently than other forms of non-small cell lung cancer. Progress in molecular diagnosis may enhance potential for accurate definition, diagnosis, and optimizing treatment approach.

KEYWORDS:

• Lung cancer
• lung adenocarcinoma
• multifocal lung cancer
• lung cancer genomics
• molecular testing

Article highlights

• Multifocal lung adenocarcinoma is a unique entity characterized by the independent development of multiple primary tumors and is often associated with an indolent clinical course.

• There is no consensus regarding the diagnostic criteria or optimal management strategy for multifocal lung adenocarcinoma.

• Next-generation sequencing technology has transformed the field of oncology through the development of individualized cancer treatment guided by the tumor’s unique genetic profile.

• NSCLC has emerged as a prototype for incorporating tumor sequencing data into clinical management.

• Comprehensive genetic analysis of multifocal lung adenocarcinoma has the potential to inform progress toward a molecular diagnosis and optimize treatment approach.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.