Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomes
Introduction: Invasive mucinous adenocarcinoma (IMA) of the lung is a distinct histologic variant of adenocarcinomas comprising about 2%–10% of lung adenocarcinomas. A large proportion of IMAs carry KRAS mutations and only rarely epidermal growth factor receptor (EGFR) mutations or ALK/ROS transloca...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Wolters Kluwer Medknow Publications
2020-01-01
|
Series: | Lung India |
Subjects: | |
Online Access: | http://www.lungindia.com/article.asp?issn=0970-2113;year=2020;volume=37;issue=6;spage=491;epage=494;aulast=Rajeev |
id |
doaj-3bdc95d2edba4b96a65f53df20da4e20 |
---|---|
record_format |
Article |
spelling |
doaj-3bdc95d2edba4b96a65f53df20da4e202020-11-25T04:08:36ZengWolters Kluwer Medknow PublicationsLung India0970-21130974-598X2020-01-0137649149410.4103/lungindia.lungindia_52_20Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomesL K RajeevAntony George Francis ThottianUsha AmirthamD LokanathaLinu Abraham JacobM C Suresh BabuK N LokeshA H RudreshaSmitha SaldanhaSyed Adil HassanIntroduction: Invasive mucinous adenocarcinoma (IMA) of the lung is a distinct histologic variant of adenocarcinomas comprising about 2%–10% of lung adenocarcinomas. A large proportion of IMAs carry KRAS mutations and only rarely epidermal growth factor receptor (EGFR) mutations or ALK/ROS translocations; thus, most cases are not amenable for targeted therapy at present. This study was conducted to elicit the unique clinicopathological characteristics of IMA. Materials and Methods: Medical records of patients diagnosed with IMA by needle biopsy at Kidwai Cancer Institute, Bangalore, from 2013 to 2018, were retrieved and reviewed. Statistical analysis was performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA). Results: Four hundred and ninety cases of needle biopsy of the lung were diagonosed at our institute between January 2013 and December 2018. Nine cases (1.8%) were diagnosed as IMA. The median age of presentation was 59 years. Six (66.7%) were current smokers with pack-year > 20. Three (33.3%) of the cases were initially misdiagnosed as pneumonia in view of computed tomography findings. The lung was the most common site of metastasis (77.8%). Serum Carcinoembryonic Antigen (CEA) was elevated in six cases (66.7%). None of the cases had any driver mutations in EGFR gene or ALK and ROS1 translocations. All cases were treated with pemetrexed–carboplatin doublet followed by pemetrexed maintenance till progression. The median progression-free survival (PFS) was 15 months (range: 5–18 months). Docetaxel was given as the second-line chemotherapy in all progressed patients. Best response noted was stable disease, seen in 4 (57.1%) cases. The median PFS for docetaxel was 6 months (range: 3–8 months). The median overall survival was 22 months (range: 9–27 months). Patients with initially raised CEA at progression had a serial rise in serum CEA. Conclusions: IMA is rarely diagnosed on needle biopsies due to insufficient tissue. They mimic pneumonia on imaging, thus delaying diagnosis. EGFR mutations, ALK, and ROS1 translocations are usually negative making them ineligible for tyrosine kinase inhibitors. Response to chemotherapy is modest.http://www.lungindia.com/article.asp?issn=0970-2113;year=2020;volume=37;issue=6;spage=491;epage=494;aulast=Rajeevinvasive mucinous carcinomamucinous adenocarcinomanon-small cell lung cancer |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
L K Rajeev Antony George Francis Thottian Usha Amirtham D Lokanatha Linu Abraham Jacob M C Suresh Babu K N Lokesh A H Rudresha Smitha Saldanha Syed Adil Hassan |
spellingShingle |
L K Rajeev Antony George Francis Thottian Usha Amirtham D Lokanatha Linu Abraham Jacob M C Suresh Babu K N Lokesh A H Rudresha Smitha Saldanha Syed Adil Hassan Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomes Lung India invasive mucinous carcinoma mucinous adenocarcinoma non-small cell lung cancer |
author_facet |
L K Rajeev Antony George Francis Thottian Usha Amirtham D Lokanatha Linu Abraham Jacob M C Suresh Babu K N Lokesh A H Rudresha Smitha Saldanha Syed Adil Hassan |
author_sort |
L K Rajeev |
title |
Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomes |
title_short |
Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomes |
title_full |
Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomes |
title_fullStr |
Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomes |
title_full_unstemmed |
Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomes |
title_sort |
primary mucinous carcinomas of the lung: clinical characteristics and treatment outcomes |
publisher |
Wolters Kluwer Medknow Publications |
series |
Lung India |
issn |
0970-2113 0974-598X |
publishDate |
2020-01-01 |
description |
Introduction: Invasive mucinous adenocarcinoma (IMA) of the lung is a distinct histologic variant of adenocarcinomas comprising about 2%–10% of lung adenocarcinomas. A large proportion of IMAs carry KRAS mutations and only rarely epidermal growth factor receptor (EGFR) mutations or ALK/ROS translocations; thus, most cases are not amenable for targeted therapy at present. This study was conducted to elicit the unique clinicopathological characteristics of IMA. Materials and Methods: Medical records of patients diagnosed with IMA by needle biopsy at Kidwai Cancer Institute, Bangalore, from 2013 to 2018, were retrieved and reviewed. Statistical analysis was performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA). Results: Four hundred and ninety cases of needle biopsy of the lung were diagonosed at our institute between January 2013 and December 2018. Nine cases (1.8%) were diagnosed as IMA. The median age of presentation was 59 years. Six (66.7%) were current smokers with pack-year > 20. Three (33.3%) of the cases were initially misdiagnosed as pneumonia in view of computed tomography findings. The lung was the most common site of metastasis (77.8%). Serum Carcinoembryonic Antigen (CEA) was elevated in six cases (66.7%). None of the cases had any driver mutations in EGFR gene or ALK and ROS1 translocations. All cases were treated with pemetrexed–carboplatin doublet followed by pemetrexed maintenance till progression. The median progression-free survival (PFS) was 15 months (range: 5–18 months). Docetaxel was given as the second-line chemotherapy in all progressed patients. Best response noted was stable disease, seen in 4 (57.1%) cases. The median PFS for docetaxel was 6 months (range: 3–8 months). The median overall survival was 22 months (range: 9–27 months). Patients with initially raised CEA at progression had a serial rise in serum CEA. Conclusions: IMA is rarely diagnosed on needle biopsies due to insufficient tissue. They mimic pneumonia on imaging, thus delaying diagnosis. EGFR mutations, ALK, and ROS1 translocations are usually negative making them ineligible for tyrosine kinase inhibitors. Response to chemotherapy is modest. |
topic |
invasive mucinous carcinoma mucinous adenocarcinoma non-small cell lung cancer |
url |
http://www.lungindia.com/article.asp?issn=0970-2113;year=2020;volume=37;issue=6;spage=491;epage=494;aulast=Rajeev |
work_keys_str_mv |
AT lkrajeev primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes AT antonygeorgefrancisthottian primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes AT ushaamirtham primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes AT dlokanatha primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes AT linuabrahamjacob primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes AT mcsureshbabu primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes AT knlokesh primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes AT ahrudresha primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes AT smithasaldanha primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes AT syedadilhassan primarymucinouscarcinomasofthelungclinicalcharacteristicsandtreatmentoutcomes |
_version_ |
1724424935297777664 |