Prospective Analysis of Genotypes in Adults Undergoing Therapy for Lung Cancer

Background:

• Lung cancer is the leading cause of cancer deaths among men and women worldwide.
• Despite modern surgical, radiation, and chemotherapeutic interventions, the prognosis for patients with lung cancer remains poor, with an overall cure rate of less than 15%.
• Genetic polymorphisms in drug-metabolizing enzymes, transporters, growth factor and hormonal receptors, DNA repair enzymes, and transcription factors might affect an individual s response to chemotherapy and radiation.
• Interindividual differences in efficacy and toxicity of cancer chemotherapy and radiation are especially important given the narrow therapeutic index of these modalities.
• Many of these differences have not been extensively explored in patients with lung cancer.

Objectives:

• To better understand the genotype-phenotype relationship between genetic polymorphisms and clinical outcomes, with a focus on overall survival, following lung cancer therapy.
• To better understand differences in outcome between Caucasian and African American patients being treated for lung cancer as a function of genotype.
• To establish a DNA repository for the investigation of polymorphisms related to outcomes in lung cancer.
• To develop methodology for the isolation, enumeration and live cell culture of circulating tumor cells (CTC) from lung cancer patients with microfiltration devices.

Eligibility:

• All individuals with the diagnosis of lung cancer being treated at the Washington D.C. Veterans Affairs Medical Center or the Medical Oncology Branch of the National Cancer Institute (NCI).

Design:

• A single 7-ml sample of venous blood will be obtained from all patients enrolled onto this study, for isolation of DNA.
• Two 5 ml samples of venous blood, drawn immediately following the 7 ml sample, will be obtained from all patients enrolled on this study at the NCI Clinical Center (only), for CTC studies.
• Polymorphisms in the following genes: ABCB1, ABCG2, COMT, CYP17, CYP19, CYP1B1, CYP1A1, CYP1A2, CYP2C8, CYP2C9, CYP2J2, CYP3A4, CYP3A5, DPYD, EPHX2, ERalpha, ERbeta, ERCC1, ERCC2, GSTP1, HIF1A, MPO, MTHFR, NQO1, p53, PPARD, SLCO1B3, TYMS, UGT1A1, VEGF, VEGFR, EGFR, SLC28A1, CDA, XRCC1, OCT1, OCT2, CHRNA3 and CHRNA5 will be analyzed by the Clinical Pharmacology Program.
• Methodology for the isolation, enumeration, and live cell culture of CTC with microfiltration devices will be developed by the NCI Genetics Branch.
• Patients will be followed at the medical oncology clinic at the Washington DC VA Medical Center or the NCI and the following information will be recorded in a confidential database: age, gender, race/ethnicity, smoking history, histology, stage, treatment(s) received, response, toxicity, time to disease progression, time to death.
• Associations between genetic polymorphisms and response to therapy, toxicity and clinical outcomes will be analyzed.
• The results of the CTC studies will be applied to the initial development and clinical

validation of CTC technology and lung cancer assays.

• INCLUSION CRITERIA:

• Patients 18 years of age and older are eligible.
• Histologic diagnosis of primary lung carcinoma. For non small cell lung cancer, patients can be stage I to IV, and receive any treatment (surgical resection, chemotherapy, radiation, molecularly targeted therapy). For small cell lung cancer, patients can be limited or extensive stage and receive any treatment (surgical resection, chemotherapy, radiation, molecularly targeted therapy).
• Patients must have a performance status of ECOG 0, 1, 2, or 3 for admission to this protocol.
• Patients with a current diagnosis of or a prior history of other cancers may be included onto this protocol.
• Patients may have either normal organ function or impaired organ function.

Exclusion criteria

• Children will not be eligible.