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1
Mappings
5
Pathophys.
5
Phenotypes
4
Genes
1
Treatments
26
References
1
Deep Research
🔗

Mappings

MONDO
MONDO:0005233 non-small cell lung carcinoma
skos:closeMatch MONDO
Closest MONDO parent term available for metastatic NSCLC.

Pathophysiology

5
Oncogenic RTK Addiction
Metastatic NSCLC is often driven by EGFR mutations, ALK fusions, ROS1 fusions, MET activation, or other kinase alterations that sustain growth, survival, and metastatic spread. These drivers create both therapeutic vulnerabilities and resistance trajectories.
cell surface receptor protein tyrosine kinase signaling pathway link ↑ INCREASED MAPK cascade link ↑ INCREASED
Show evidence (1 reference)
PMID:29989448 SUPPORT Human Clinical
"Activating mutations in the EGFR and rearrangements in the anaplastic lymphoma kinase (ALK) or ROS proto-oncogene 1 receptor tyrosine kinase (ROS1) genes have been identified as oncogenic drivers in non-small-cell lung cancer."
This directly supports the major driver pathways relevant to metastatic NSCLC.
EMT and Invasion
NSCLC cells adopt EMT programs to detach from primary lesions, invade surrounding stroma, and survive transit to distant sites. EMT also contributes to resistance to targeted therapy and immune-mediated clearance.
epithelial to mesenchymal transition link ↑ INCREASED cell migration link ↑ INCREASED positive regulation of cell migration link ↑ INCREASED
PD-L1 Adaptive Immune Resistance
PD-L1 expression in metastatic NSCLC reflects adaptive immune resistance in response to interferon-rich T-cell infiltrates and can blunt antitumor immunity at primary and metastatic sites.
negative regulation of immune response link ↑ INCREASED
Show evidence (1 reference)
PMID:31627272 SUPPORT Human Clinical
"Aberrant expression of programmed death ligand 1 (PD-L1) on tumor cells impedes antitumor immunity and instigates immune evasion."
This directly supports immune evasion through PD-L1 in NSCLC.
Brain Metastasis Seed-and-Soil Biology
Brain metastases arise when circulating NSCLC cells survive vascular arrest, cross the blood-brain barrier, and adapt to the neural microenvironment. Organ microenvironmental interactions are major determinants of treatment resistance in cerebral disease.
cell migration link ↑ INCREASED
Show evidence (1 reference)
PMID:26222080 SUPPORT Human Clinical
"These findings substantiate the importance of the "seed and soil" hypothesis and that successful treatment of brain metastases must include targeting of the organ microenvironment."
This supports organ-specific microenvironmental control of NSCLC brain metastasis behavior.
Angiogenesis and Vascular Remodeling
Metastatic NSCLC lesions require neovascular support, and vascular remodeling contributes to tumor growth in lung, brain, and bone niches.
angiogenesis link ↑ INCREASED

Phenotypes

5
Nervous System 1
Headache FREQUENT Headache (HP:0002315)
Respiratory 1
Dyspnea VERY_FREQUENT Dyspnea (HP:0002094)
Constitutional 2
Bone pain FREQUENT Bone pain (HP:0002653)
Fatigue VERY_FREQUENT Fatigue (HP:0012378)
Growth 1
Weight loss VERY_FREQUENT Weight loss (HP:0001824)
🧬

Genetic Associations

4
EGFR (Somatic activating mutation)
Show evidence (1 reference)
"EGFR | HGNC:3236 | non-small cell lung carcinoma | MONDO:0005233 | AD | Definitive"
ClinGen classifies the EGFR-non-small cell lung carcinoma gene-disease relationship as definitive with autosomal dominant inheritance.
ALK (Oncogenic rearrangement)
ROS1 (Oncogenic rearrangement)
STK11/KEAP1 (Co-mutation linked to immune resistance)
💊

Treatments

1
Pembrolizumab-Based Immune Checkpoint Therapy
Action: immunotherapy Ontology label: Immunotherapy NCIT:C15262
Agent: pembrolizumab
Immune checkpoint inhibitor therapy is a major systemic treatment class in metastatic non-small cell lung cancer, with pembrolizumab-based regimens selected according to PD-L1 expression, tumor genotype, histology, and chemotherapy eligibility.
Show evidence (1 reference)
DOI:10.1093/jnci/djae118 SUPPORT Human Clinical
"Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non–small cell lung cancer."
Population-level metastatic NSCLC evidence supports immune checkpoint inhibitors as survival-impacting systemic therapy.
🌍

Environmental Factors

1
Tobacco smoking
Tobacco exposure remains the dominant NSCLC risk factor and shapes mutational complexity.
{ }

Source YAML

click to show
name: Metastatic Non-Small Cell Lung Cancer
creation_date: '2026-03-28T21:20:00Z'
updated_date: '2026-05-10T08:24:09Z'
description: >-
  Metastatic non-small cell lung cancer (NSCLC) is advanced NSCLC with dissemination
  to distant organs, particularly brain, bone, liver, adrenal gland, and pleura.
  Metastatic behavior is shaped by oncogenic receptor tyrosine kinase signaling,
  epithelial plasticity, angiogenesis, immune checkpoint engagement, and organ-specific
  interactions within the brain and bone microenvironments.
categories:
- Lung Cancer
- Metastatic Cancer
- Solid Tumor
parents:
- non-small cell lung carcinoma
disease_term:
  preferred_term: metastatic non-small cell lung carcinoma
  term:
    id: MONDO:0005233
    label: non-small cell lung carcinoma
mappings:
  mondo_mappings:
  - term:
      id: MONDO:0005233
      label: non-small cell lung carcinoma
    mapping_predicate: skos:closeMatch
    mapping_source: MONDO
    mapping_justification: Closest MONDO parent term available for metastatic NSCLC.
prevalence:
- population: Advanced NSCLC treated with nivolumab
  percentage: 15.6
  notes: Estimated 5-year survival in a heavily pretreated advanced NSCLC cohort.
  evidence:
  - reference: PMID:31343665
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: Overall survival curves showed estimated 5-year rates of 34.2% among patients with melanoma, 27.7% among patients with RCC, and 15.6% among patients with NSCLC.
    explanation: This provides a 5-year survival benchmark for advanced NSCLC.
pathophysiology:
- name: Oncogenic RTK Addiction
  description: >-
    Metastatic NSCLC is often driven by EGFR mutations, ALK fusions, ROS1 fusions,
    MET
    activation, or other kinase alterations that sustain growth, survival, and metastatic
    spread. These drivers create both therapeutic vulnerabilities and resistance trajectories.
  evidence:
  - reference: PMID:29989448
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: Activating mutations in the EGFR and rearrangements in the anaplastic lymphoma kinase (ALK) or ROS proto-oncogene 1 receptor tyrosine kinase (ROS1) genes have been identified as oncogenic drivers in non-small-cell lung cancer.
    explanation: This directly supports the major driver pathways relevant to metastatic NSCLC.
  biological_processes:
  - preferred_term: cell surface receptor protein tyrosine kinase signaling pathway
    modifier: INCREASED
    term:
      id: GO:0007169
      label: cell surface receptor protein tyrosine kinase signaling pathway
  - preferred_term: MAPK cascade
    modifier: INCREASED
    term:
      id: GO:0000165
      label: MAPK cascade
- name: EMT and Invasion
  description: >-
    NSCLC cells adopt EMT programs to detach from primary lesions, invade surrounding
    stroma,
    and survive transit to distant sites. EMT also contributes to resistance to targeted
    therapy and immune-mediated clearance.
  biological_processes:
  - preferred_term: epithelial to mesenchymal transition
    modifier: INCREASED
    term:
      id: GO:0001837
      label: epithelial to mesenchymal transition
  - preferred_term: cell migration
    modifier: INCREASED
    term:
      id: GO:0016477
      label: cell migration
  - preferred_term: positive regulation of cell migration
    modifier: INCREASED
    term:
      id: GO:0030335
      label: positive regulation of cell migration
- name: PD-L1 Adaptive Immune Resistance
  description: >-
    PD-L1 expression in metastatic NSCLC reflects adaptive immune resistance in response
    to
    interferon-rich T-cell infiltrates and can blunt antitumor immunity at primary
    and
    metastatic sites.
  evidence:
  - reference: PMID:31627272
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: Aberrant expression of programmed death ligand 1 (PD-L1) on tumor cells impedes antitumor immunity and instigates immune evasion.
    explanation: This directly supports immune evasion through PD-L1 in NSCLC.
  biological_processes:
  - preferred_term: negative regulation of immune response
    modifier: INCREASED
    term:
      id: GO:0050777
      label: negative regulation of immune response
- name: Brain Metastasis Seed-and-Soil Biology
  description: >-
    Brain metastases arise when circulating NSCLC cells survive vascular arrest, cross
    the
    blood-brain barrier, and adapt to the neural microenvironment. Organ microenvironmental
    interactions are major determinants of treatment resistance in cerebral disease.
  evidence:
  - reference: PMID:26222080
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: These findings substantiate the importance of the "seed and soil" hypothesis and that successful treatment of brain metastases must include targeting of the organ microenvironment.
    explanation: This supports organ-specific microenvironmental control of NSCLC brain metastasis behavior.
  biological_processes:
  - preferred_term: cell migration
    modifier: INCREASED
    term:
      id: GO:0016477
      label: cell migration
- name: Angiogenesis and Vascular Remodeling
  description: >-
    Metastatic NSCLC lesions require neovascular support, and vascular remodeling
    contributes
    to tumor growth in lung, brain, and bone niches.
  biological_processes:
  - preferred_term: angiogenesis
    modifier: INCREASED
    term:
      id: GO:0001525
      label: angiogenesis
phenotypes:
- category: Respiratory
  name: Dyspnea
  frequency: VERY_FREQUENT
  description: Dyspnea reflects thoracic disease burden, pleural disease, or lymphangitic spread.
  phenotype_term:
    preferred_term: Dyspnea
    term:
      id: HP:0002094
      label: Dyspnea
- category: Neurologic
  name: Headache
  frequency: FREQUENT
  description: Headache is common when NSCLC metastasizes to the brain.
  phenotype_term:
    preferred_term: Headache
    term:
      id: HP:0002315
      label: Headache
- category: Musculoskeletal
  name: Bone pain
  frequency: FREQUENT
  description: Bone metastases often cause pain, vertebral collapse risk, and skeletal-related events.
  phenotype_term:
    preferred_term: Bone pain
    term:
      id: HP:0002653
      label: Bone pain
- category: Constitutional
  name: Weight loss
  frequency: VERY_FREQUENT
  description: Metastatic NSCLC frequently causes catabolic weight loss.
  phenotype_term:
    preferred_term: Weight loss
    term:
      id: HP:0001824
      label: Weight loss
- category: Constitutional
  name: Fatigue
  frequency: VERY_FREQUENT
  description: Fatigue is common from inflammatory burden, hypoxemia, anemia, and treatment.
  phenotype_term:
    preferred_term: Fatigue
    term:
      id: HP:0012378
      label: Fatigue
genetic:
- name: EGFR
  association: Somatic activating mutation
  evidence:
  - reference: CGGV:assertion_49342c73-96d7-45ba-9c90-d2d5e5710636-2020-07-30T202207.418Z
    reference_title: "EGFR / non-small cell lung carcinoma (Definitive)"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "EGFR | HGNC:3236 | non-small cell lung carcinoma | MONDO:0005233 | AD | Definitive"
    explanation: ClinGen classifies the EGFR-non-small cell lung carcinoma gene-disease relationship as definitive with autosomal dominant inheritance.
  notes: EGFR mutations drive metastatic behavior and create dependence on EGFR signaling.
- name: ALK
  association: Oncogenic rearrangement
  notes: ALK fusions are associated with visceral and brain metastatic spread and targeted therapy sensitivity.
- name: ROS1
  association: Oncogenic rearrangement
  notes: ROS1 fusions define a kinase-driven metastatic subset of NSCLC.
- name: STK11/KEAP1
  association: Co-mutation linked to immune resistance
  notes: STK11 and KEAP1 alterations can create immune-cold metastatic disease and worse checkpoint inhibitor response.
environmental:
- name: Tobacco smoking
  notes: Tobacco exposure remains the dominant NSCLC risk factor and shapes mutational complexity.
notes: >-
  Metastatic NSCLC couples oncogenic kinase addiction with immune checkpoint adaptation
  and
  strong organotropism to brain and bone. Brain metastasis biology is especially dependent
  on seed-and-soil interactions with the neural microenvironment.
treatments:
- name: Pembrolizumab-Based Immune Checkpoint Therapy
  description: Immune checkpoint inhibitor therapy is a major systemic treatment class in metastatic non-small cell lung cancer, with pembrolizumab-based regimens selected according to PD-L1 expression, tumor genotype, histology, and chemotherapy eligibility.
  treatment_term:
    preferred_term: immunotherapy
    term:
      id: NCIT:C15262
      label: Immunotherapy
    therapeutic_agent:
    - preferred_term: pembrolizumab
      term:
        id: NCIT:C106432
        label: Pembrolizumab
  evidence:
  - reference: DOI:10.1093/jnci/djae118
    reference_title: Racial and socioeconomic disparities in survival among patients with metastatic non–small cell lung cancer
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non–small cell lung cancer.
    explanation: Population-level metastatic NSCLC evidence supports immune checkpoint inhibitors as survival-impacting systemic therapy.
references:
- reference: DOI:10.1016/j.xcrm.2024.101777
  title: Modeling lung adenocarcinoma metastases using patient-derived organoids
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Modeling lung adenocarcinoma metastases using patient-derived organoids
    supporting_text: Modeling lung adenocarcinoma metastases using patient-derived organoids
- reference: DOI:10.1038/s41392-024-01897-y
  title: 'SHR-A1811 (antibody-drug conjugate) in advanced HER2-mutant non-small cell lung cancer: a multicenter, open-label, phase 1/2 study'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: A dose-escalation and expansion, phase 1/2 study (ClinicalTrials.gov, NCT04818333) was conducted to assess the novel antibody-drug conjugate SHR-A1811 in pretreated HER2-altered advanced non-small cell lung cancer (NSCLC).
    supporting_text: A dose-escalation and expansion, phase 1/2 study (ClinicalTrials.gov, NCT04818333) was conducted to assess the novel antibody-drug conjugate SHR-A1811 in pretreated HER2-altered advanced non-small cell lung cancer (NSCLC).
    evidence:
    - reference: DOI:10.1038/s41392-024-01897-y
      reference_title: 'SHR-A1811 (antibody-drug conjugate) in advanced HER2-mutant non-small cell lung cancer: a multicenter, open-label, phase 1/2 study'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: A dose-escalation and expansion, phase 1/2 study (ClinicalTrials.gov, NCT04818333) was conducted to assess the novel antibody-drug conjugate SHR-A1811 in pretreated HER2-altered advanced non-small cell lung cancer (NSCLC).
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.1038/s41416-024-02895-1
  title: 'Real-world evidence for pembrolizumab in non-small cell lung cancer: a nationwide cohort study'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: 'Real-world evidence for pembrolizumab in non-small cell lung cancer: a nationwide cohort study'
    supporting_text: Based on favourable results from clinical trials, immune checkpoint inhibitors (ICI) have become the standard first line (1 L) systemic anticancer treatment (SACT) for advanced stage non-small cell lung cancer (NSCLC) without targetable mutations.
    evidence:
    - reference: DOI:10.1038/s41416-024-02895-1
      reference_title: 'Real-world evidence for pembrolizumab in non-small cell lung cancer: a nationwide cohort study'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Based on favourable results from clinical trials, immune checkpoint inhibitors (ICI) have become the standard first line (1 L) systemic anticancer treatment (SACT) for advanced stage non-small cell lung cancer (NSCLC) without targetable mutations.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.1038/s41467-024-47547-3
  title: Representation of genomic intratumor heterogeneity in multi-region non-small cell lung cancer patient-derived xenograft models
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Patient-derived xenograft (PDX) models are widely used in cancer research.
    supporting_text: Patient-derived xenograft (PDX) models are widely used in cancer research.
    evidence:
    - reference: DOI:10.1038/s41467-024-47547-3
      reference_title: Representation of genomic intratumor heterogeneity in multi-region non-small cell lung cancer patient-derived xenograft models
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Patient-derived xenograft (PDX) models are widely used in cancer research.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.1038/s41598-024-73389-6
  title: Distant metastasis patterns among lung cancer subtypes and impact of primary tumor resection on survival in metastatic lung cancer using SEER database
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Distant metastasis patterns among lung cancer subtypes and impact of primary tumor resection on survival in metastatic lung cancer using SEER database
    supporting_text: Distant metastasis patterns among lung cancer subtypes and impact of primary tumor resection on survival in metastatic lung cancer using SEER database
- reference: DOI:10.1038/s41698-024-00609-7
  title: Prediction of TKI response in EGFR-mutant lung cancer patients-derived organoids using malignant pleural effusion
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Patient-derived organoids (PDOs) are valuable in predicting response to cancer therapy.
    supporting_text: Patient-derived organoids (PDOs) are valuable in predicting response to cancer therapy.
    evidence:
    - reference: DOI:10.1038/s41698-024-00609-7
      reference_title: Prediction of TKI response in EGFR-mutant lung cancer patients-derived organoids using malignant pleural effusion
      supports: SUPPORT
      evidence_source: COMPUTATIONAL
      snippet: Patient-derived organoids (PDOs) are valuable in predicting response to cancer therapy.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.1056/nejmoa2403614
  title: Amivantamab plus Lazertinib in Previously Untreated <i>EGFR</i> -Mutated Advanced NSCLC
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Amivantamab plus Lazertinib in Previously Untreated <i>EGFR</i> -Mutated Advanced NSCLC
    supporting_text: Amivantamab plus Lazertinib in Previously Untreated <i>EGFR</i> -Mutated Advanced NSCLC
- reference: DOI:10.1093/jnci/djae118
  title: Racial and socioeconomic disparities in survival among patients with metastatic non–small cell lung cancer
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non–small cell lung cancer.
    supporting_text: Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non–small cell lung cancer.
    evidence:
    - reference: DOI:10.1093/jnci/djae118
      reference_title: Racial and socioeconomic disparities in survival among patients with metastatic non–small cell lung cancer
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non–small cell lung cancer.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.1177/17588359241231260
  title: 'Geographic differences in lung cancer: focus on carcinogens, genetic predisposition, and molecular epidemiology'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Lung cancer poses a global health challenge and stands as the leading cause of cancer-related deaths worldwide.
    supporting_text: Lung cancer poses a global health challenge and stands as the leading cause of cancer-related deaths worldwide.
    evidence:
    - reference: DOI:10.1177/17588359241231260
      reference_title: 'Geographic differences in lung cancer: focus on carcinogens, genetic predisposition, and molecular epidemiology'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Lung cancer poses a global health challenge and stands as the leading cause of cancer-related deaths worldwide.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.1177/17588359241303090
  title: 'Femoral bone metastasis is a poor prognostic factor in EGFR-TKIs-treated patients with <i>EGFR</i> -mutated non-small-cell lung cancer: a retrospective, multicenter cohort study'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Epidermal growth factor receptor ( EGFR)-mutant non-small-cell lung cancers (NSCLCs) have higher frequencies of bone metastases than those of wild type; however, the metastatic pattern and influence on clinical outcome remain unclear.
    supporting_text: Epidermal growth factor receptor ( EGFR)-mutant non-small-cell lung cancers (NSCLCs) have higher frequencies of bone metastases than those of wild type; however, the metastatic pattern and influence on clinical outcome remain unclear.
    evidence:
    - reference: DOI:10.1177/17588359241303090
      reference_title: 'Femoral bone metastasis is a poor prognostic factor in EGFR-TKIs-treated patients with <i>EGFR</i> -mutated non-small-cell lung cancer: a retrospective, multicenter cohort study'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Epidermal growth factor receptor ( EGFR)-mutant non-small-cell lung cancers (NSCLCs) have higher frequencies of bone metastases than those of wild type; however, the metastatic pattern and influence on clinical outcome remain unclear.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.1186/s10020-024-00934-4
  title: Utility of patient-derived xenografts to evaluate drug sensitivity and select optimal treatments for individual non-small-cell lung cancer patients
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Patient-derived xenograft (PDX) is currently considered a preferred preclinical model to evaluate drug sensitivity, explore drug resistance mechanisms, and select individualized treatment regimens.
    supporting_text: Patient-derived xenograft (PDX) is currently considered a preferred preclinical model to evaluate drug sensitivity, explore drug resistance mechanisms, and select individualized treatment regimens.
    evidence:
    - reference: DOI:10.1186/s10020-024-00934-4
      reference_title: Utility of patient-derived xenografts to evaluate drug sensitivity and select optimal treatments for individual non-small-cell lung cancer patients
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Patient-derived xenograft (PDX) is currently considered a preferred preclinical model to evaluate drug sensitivity, explore drug resistance mechanisms, and select individualized treatment regimens.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.1186/s12957-024-03449-8
  title: 'Efficacy and toxicity of KRASG12C inhibitors in advanced solid tumors: a meta-analysis'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: The efficacy and toxicity of KRASG12C inhibitors were evaluated for advanced solid tumors in several studies; however, the results were not fully consistent.
    supporting_text: The efficacy and toxicity of KRASG12C inhibitors were evaluated for advanced solid tumors in several studies; however, the results were not fully consistent.
    evidence:
    - reference: DOI:10.1186/s12957-024-03449-8
      reference_title: 'Efficacy and toxicity of KRASG12C inhibitors in advanced solid tumors: a meta-analysis'
      supports: SUPPORT
      evidence_source: OTHER
      snippet: The efficacy and toxicity of KRASG12C inhibitors were evaluated for advanced solid tumors in several studies; however, the results were not fully consistent.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.1200/oa.24.00008
  title: 'Disparities in Utilization of Immune Checkpoint Inhibitor Therapy Among Older Patients With Advanced Non–Small Cell Lung Cancer: A SEER-Medicare Analysis'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: In the United States, there are disparities in access to care for patients with non–small cell lung cancer (NSCLC) on the basis of socioeconomic and racial/ethnic factors.
    supporting_text: In the United States, there are disparities in access to care for patients with non–small cell lung cancer (NSCLC) on the basis of socioeconomic and racial/ethnic factors.
    evidence:
    - reference: DOI:10.1200/oa.24.00008
      reference_title: 'Disparities in Utilization of Immune Checkpoint Inhibitor Therapy Among Older Patients With Advanced Non–Small Cell Lung Cancer: A SEER-Medicare Analysis'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: In the United States, there are disparities in access to care for patients with non–small cell lung cancer (NSCLC) on the basis of socioeconomic and racial/ethnic factors.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.18502/jhsw.v14i1.17131
  title: 'Investigating the Relationship Between Exposure to Cadmium and Lung Cancer Risk: A Systematic Review and Meta-analysis'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Lung cancer is the second most common cancer in the world.
    supporting_text: Lung cancer is the second most common cancer in the world.
    evidence:
    - reference: DOI:10.18502/jhsw.v14i1.17131
      reference_title: 'Investigating the Relationship Between Exposure to Cadmium and Lung Cancer Risk: A Systematic Review and Meta-analysis'
      supports: SUPPORT
      evidence_source: OTHER
      snippet: Lung cancer is the second most common cancer in the world.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.21037/tlcr-24-856
  title: A potential central nervous system niche for trastuzumab deruxtecan in patients with HER2-expressing non-small cell lung cancer
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: A potential central nervous system niche for trastuzumab deruxtecan in patients with HER2-expressing non-small cell lung cancer
    supporting_text: A potential central nervous system niche for trastuzumab deruxtecan in patients with HER2-expressing non-small cell lung cancer
- reference: DOI:10.2147/dddt.s466217
  title: 'Adagrasib in the Treatment of KRAS p.G12C Positive Advanced NSCLC: Design, Development and Place in Therapy'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: 'Adagrasib in the Treatment of KRAS p.G12C Positive Advanced NSCLC: Design, Development and Place in Therapy'
    supporting_text: 'Adagrasib in the Treatment of KRAS p.G12C Positive Advanced NSCLC: Design, Development and Place in Therapy'
- reference: DOI:10.3322/caac.21811
  title: 'Screening for lung cancer: 2023 guideline update from the American Cancer Society'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Lung cancer is the leading cause of mortality and person‐years of life lost from cancer among US men and women.
    supporting_text: Lung cancer is the leading cause of mortality and person‐years of life lost from cancer among US men and women.
    evidence:
    - reference: DOI:10.3322/caac.21811
      reference_title: 'Screening for lung cancer: 2023 guideline update from the American Cancer Society'
      supports: SUPPORT
      evidence_source: OTHER
      snippet: Lung cancer is the leading cause of mortality and person‐years of life lost from cancer among US men and women.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.3389/fonc.2023.1241402
  title: 'Non-small cell lung cancer with MET amplification: review of epidemiology, associated disease characteristics, testing procedures, burden, and treatments'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Mesenchymal-epidermal transition factor gene amplification (METamp) is being investigated as a therapeutic target in advanced non-small cell lung cancer (NSCLC).
    supporting_text: Mesenchymal-epidermal transition factor gene amplification (METamp) is being investigated as a therapeutic target in advanced non-small cell lung cancer (NSCLC).
    evidence:
    - reference: DOI:10.3389/fonc.2023.1241402
      reference_title: 'Non-small cell lung cancer with MET amplification: review of epidemiology, associated disease characteristics, testing procedures, burden, and treatments'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Mesenchymal-epidermal transition factor gene amplification (METamp) is being investigated as a therapeutic target in advanced non-small cell lung cancer (NSCLC).
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.3389/fonc.2024.1328728
  title: Mechanisms of resistance to KRASG12C inhibitors in KRASG12C-mutated non-small cell lung cancer
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: The KRAS protein, a product of the KRAS gene (V-ki-ras2 Kirsten rat sarcoma viral oncogene homolog), functions as a small GTPase that alternates between an active GTP-bound state (KRAS(ON)) and an inactive GDP-bound state (KRAS(OFF)).
    supporting_text: The KRAS protein, a product of the KRAS gene (V-ki-ras2 Kirsten rat sarcoma viral oncogene homolog), functions as a small GTPase that alternates between an active GTP-bound state (KRAS(ON)) and an inactive GDP-bound state (KRAS(OFF)).
    evidence:
    - reference: DOI:10.3389/fonc.2024.1328728
      reference_title: Mechanisms of resistance to KRASG12C inhibitors in KRASG12C-mutated non-small cell lung cancer
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: The KRAS protein, a product of the KRAS gene (V-ki-ras2 Kirsten rat sarcoma viral oncogene homolog), functions as a small GTPase that alternates between an active GTP-bound state (KRAS(ON)) and an inactive GDP-bound state (KRAS(OFF)).
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.3389/fonc.2024.1442909
  title: Real-world treatment patterns, biomarker testing, and clinical outcomes of metastatic non-small cell lung cancer patients in the immunotherapy era
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Treatment for first-line (1L) metastatic non-small cell cancer (mNSCLC) changed with the introduction of immunotherapy.
    supporting_text: Treatment for first-line (1L) metastatic non-small cell cancer (mNSCLC) changed with the introduction of immunotherapy.
    evidence:
    - reference: DOI:10.3389/fonc.2024.1442909
      reference_title: Real-world treatment patterns, biomarker testing, and clinical outcomes of metastatic non-small cell lung cancer patients in the immunotherapy era
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Treatment for first-line (1L) metastatic non-small cell cancer (mNSCLC) changed with the introduction of immunotherapy.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.3390/cancers16112018
  title: 'HER2-Altered Non-Small Cell Lung Cancer: A Journey from Current Approaches to Emerging Strategies'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: For patients diagnosed with advanced HER2-altered non-small cell lung cancer (NSCLC), the current standard of care is represented by a platinum-pemetrexed-based chemotherapy, eventually in combination with immunotherapy.
    supporting_text: For patients diagnosed with advanced HER2-altered non-small cell lung cancer (NSCLC), the current standard of care is represented by a platinum-pemetrexed-based chemotherapy, eventually in combination with immunotherapy.
    evidence:
    - reference: DOI:10.3390/cancers16112018
      reference_title: 'HER2-Altered Non-Small Cell Lung Cancer: A Journey from Current Approaches to Emerging Strategies'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: For patients diagnosed with advanced HER2-altered non-small cell lung cancer (NSCLC), the current standard of care is represented by a platinum-pemetrexed-based chemotherapy, eventually in combination with immunotherapy.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.3390/cancers16112136
  title: Site-Specific Response and Resistance Patterns in Patients with Advanced Non-Small-Cell Lung Cancer Treated with First-Line Systemic Therapy
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Patients with advanced NSCLC have heterogenous responses to immune checkpoint inhibitors (ICIs) with or without chemotherapy.
    supporting_text: Patients with advanced NSCLC have heterogenous responses to immune checkpoint inhibitors (ICIs) with or without chemotherapy.
    evidence:
    - reference: DOI:10.3390/cancers16112136
      reference_title: Site-Specific Response and Resistance Patterns in Patients with Advanced Non-Small-Cell Lung Cancer Treated with First-Line Systemic Therapy
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Patients with advanced NSCLC have heterogenous responses to immune checkpoint inhibitors (ICIs) with or without chemotherapy.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.3390/cancers16132338
  title: 'Identification and Application of Emerging Biomarkers in Treatment of Non-Small-Cell Lung Cancer: Systematic Review'
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Non-small-cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, often diagnosed at advanced stages, which diminishes the effective treatment options and survival rates.
    supporting_text: Non-small-cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, often diagnosed at advanced stages, which diminishes the effective treatment options and survival rates.
    evidence:
    - reference: DOI:10.3390/cancers16132338
      reference_title: 'Identification and Application of Emerging Biomarkers in Treatment of Non-Small-Cell Lung Cancer: Systematic Review'
      supports: SUPPORT
      evidence_source: OTHER
      snippet: Non-small-cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, often diagnosed at advanced stages, which diminishes the effective treatment options and survival rates.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.3390/cancers16132350
  title: Evolving Precision First-Line Systemic Treatment for Patients with Unresectable Non-Small Cell Lung Cancer
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: First-line systemic therapy for patients with advanced or metastatic non-small cell lung cancer (NSCLC) has rapidly evolved over the past two decades.
    supporting_text: First-line systemic therapy for patients with advanced or metastatic non-small cell lung cancer (NSCLC) has rapidly evolved over the past two decades.
    evidence:
    - reference: DOI:10.3390/cancers16132350
      reference_title: Evolving Precision First-Line Systemic Treatment for Patients with Unresectable Non-Small Cell Lung Cancer
      supports: SUPPORT
      evidence_source: COMPUTATIONAL
      snippet: First-line systemic therapy for patients with advanced or metastatic non-small cell lung cancer (NSCLC) has rapidly evolved over the past two decades.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.37349/etat.2024.00277
  title: Addressing the unmet need in NSCLC progression with advances in second-line therapeutics
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: Lung cancer is the leading cause of cancer mortality globally, with non-small cell lung cancer (NSCLC) accounting for 85% of cases.
    supporting_text: Lung cancer is the leading cause of cancer mortality globally, with non-small cell lung cancer (NSCLC) accounting for 85% of cases.
    evidence:
    - reference: DOI:10.37349/etat.2024.00277
      reference_title: Addressing the unmet need in NSCLC progression with advances in second-line therapeutics
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: Lung cancer is the leading cause of cancer mortality globally, with non-small cell lung cancer (NSCLC) accounting for 85% of cases.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
- reference: DOI:10.4046/trd.2024.0092
  title: Update in Association between Lung Cancer and Air Pollution
  found_in:
  - Metastatic_NSCLC-deep-research-falcon.md
  findings:
  - statement: A significant portion of newly diagnosed lung cancer cases occurs in populations exposed to air pollution.
    supporting_text: A significant portion of newly diagnosed lung cancer cases occurs in populations exposed to air pollution.
    evidence:
    - reference: DOI:10.4046/trd.2024.0092
      reference_title: Update in Association between Lung Cancer and Air Pollution
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: A significant portion of newly diagnosed lung cancer cases occurs in populations exposed to air pollution.
      explanation: Deep research cited this publication as relevant literature for Metastatic NSCLC.
📚

References & Deep Research

References

26
Modeling lung adenocarcinoma metastases using patient-derived organoids
1 finding
Modeling lung adenocarcinoma metastases using patient-derived organoids
"Modeling lung adenocarcinoma metastases using patient-derived organoids"
SHR-A1811 (antibody-drug conjugate) in advanced HER2-mutant non-small cell lung cancer: a multicenter, open-label, phase 1/2 study
1 finding
A dose-escalation and expansion, phase 1/2 study (ClinicalTrials.gov, NCT04818333) was conducted to assess the novel antibody-drug conjugate SHR-A1811 in pretreated HER2-altered advanced non-small cell lung cancer (NSCLC).
"A dose-escalation and expansion, phase 1/2 study (ClinicalTrials.gov, NCT04818333) was conducted to assess the novel antibody-drug conjugate SHR-A1811 in pretreated HER2-altered advanced non-small cell lung cancer (NSCLC)."
Show evidence (1 reference)
DOI:10.1038/s41392-024-01897-y SUPPORT Human Clinical
"A dose-escalation and expansion, phase 1/2 study (ClinicalTrials.gov, NCT04818333) was conducted to assess the novel antibody-drug conjugate SHR-A1811 in pretreated HER2-altered advanced non-small cell lung cancer (NSCLC)."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Real-world evidence for pembrolizumab in non-small cell lung cancer: a nationwide cohort study
1 finding
Real-world evidence for pembrolizumab in non-small cell lung cancer: a nationwide cohort study
"Based on favourable results from clinical trials, immune checkpoint inhibitors (ICI) have become the standard first line (1 L) systemic anticancer treatment (SACT) for advanced stage non-small cell lung cancer (NSCLC) without targetable mutations."
Show evidence (1 reference)
DOI:10.1038/s41416-024-02895-1 SUPPORT Human Clinical
"Based on favourable results from clinical trials, immune checkpoint inhibitors (ICI) have become the standard first line (1 L) systemic anticancer treatment (SACT) for advanced stage non-small cell lung cancer (NSCLC) without targetable mutations."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Representation of genomic intratumor heterogeneity in multi-region non-small cell lung cancer patient-derived xenograft models
1 finding
Patient-derived xenograft (PDX) models are widely used in cancer research.
"Patient-derived xenograft (PDX) models are widely used in cancer research."
Show evidence (1 reference)
DOI:10.1038/s41467-024-47547-3 SUPPORT Human Clinical
"Patient-derived xenograft (PDX) models are widely used in cancer research."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Distant metastasis patterns among lung cancer subtypes and impact of primary tumor resection on survival in metastatic lung cancer using SEER database
1 finding
Distant metastasis patterns among lung cancer subtypes and impact of primary tumor resection on survival in metastatic lung cancer using SEER database
"Distant metastasis patterns among lung cancer subtypes and impact of primary tumor resection on survival in metastatic lung cancer using SEER database"
Prediction of TKI response in EGFR-mutant lung cancer patients-derived organoids using malignant pleural effusion
1 finding
Patient-derived organoids (PDOs) are valuable in predicting response to cancer therapy.
"Patient-derived organoids (PDOs) are valuable in predicting response to cancer therapy."
Show evidence (1 reference)
DOI:10.1038/s41698-024-00609-7 SUPPORT Computational
"Patient-derived organoids (PDOs) are valuable in predicting response to cancer therapy."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Amivantamab plus Lazertinib in Previously Untreated <i>EGFR</i> -Mutated Advanced NSCLC
1 finding
Amivantamab plus Lazertinib in Previously Untreated <i>EGFR</i> -Mutated Advanced NSCLC
"Amivantamab plus Lazertinib in Previously Untreated <i>EGFR</i> -Mutated Advanced NSCLC"
Racial and socioeconomic disparities in survival among patients with metastatic non–small cell lung cancer
1 finding
Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non–small cell lung cancer.
"Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non–small cell lung cancer."
Show evidence (1 reference)
DOI:10.1093/jnci/djae118 SUPPORT Human Clinical
"Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non–small cell lung cancer."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Geographic differences in lung cancer: focus on carcinogens, genetic predisposition, and molecular epidemiology
1 finding
Lung cancer poses a global health challenge and stands as the leading cause of cancer-related deaths worldwide.
"Lung cancer poses a global health challenge and stands as the leading cause of cancer-related deaths worldwide."
Show evidence (1 reference)
DOI:10.1177/17588359241231260 SUPPORT Human Clinical
"Lung cancer poses a global health challenge and stands as the leading cause of cancer-related deaths worldwide."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Femoral bone metastasis is a poor prognostic factor in EGFR-TKIs-treated patients with <i>EGFR</i> -mutated non-small-cell lung cancer: a retrospective, multicenter cohort study
1 finding
Epidermal growth factor receptor ( EGFR)-mutant non-small-cell lung cancers (NSCLCs) have higher frequencies of bone metastases than those of wild type; however, the metastatic pattern and influence on clinical outcome remain unclear.
"Epidermal growth factor receptor ( EGFR)-mutant non-small-cell lung cancers (NSCLCs) have higher frequencies of bone metastases than those of wild type; however, the metastatic pattern and influence on clinical outcome remain unclear."
Show evidence (1 reference)
DOI:10.1177/17588359241303090 SUPPORT Human Clinical
"Epidermal growth factor receptor ( EGFR)-mutant non-small-cell lung cancers (NSCLCs) have higher frequencies of bone metastases than those of wild type; however, the metastatic pattern and influence on clinical outcome remain unclear."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Utility of patient-derived xenografts to evaluate drug sensitivity and select optimal treatments for individual non-small-cell lung cancer patients
1 finding
Patient-derived xenograft (PDX) is currently considered a preferred preclinical model to evaluate drug sensitivity, explore drug resistance mechanisms, and select individualized treatment regimens.
"Patient-derived xenograft (PDX) is currently considered a preferred preclinical model to evaluate drug sensitivity, explore drug resistance mechanisms, and select individualized treatment regimens."
Show evidence (1 reference)
DOI:10.1186/s10020-024-00934-4 SUPPORT Human Clinical
"Patient-derived xenograft (PDX) is currently considered a preferred preclinical model to evaluate drug sensitivity, explore drug resistance mechanisms, and select individualized treatment regimens."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Efficacy and toxicity of KRASG12C inhibitors in advanced solid tumors: a meta-analysis
1 finding
The efficacy and toxicity of KRASG12C inhibitors were evaluated for advanced solid tumors in several studies; however, the results were not fully consistent.
"The efficacy and toxicity of KRASG12C inhibitors were evaluated for advanced solid tumors in several studies; however, the results were not fully consistent."
Show evidence (1 reference)
"The efficacy and toxicity of KRASG12C inhibitors were evaluated for advanced solid tumors in several studies; however, the results were not fully consistent."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Disparities in Utilization of Immune Checkpoint Inhibitor Therapy Among Older Patients With Advanced Non–Small Cell Lung Cancer: A SEER-Medicare Analysis
1 finding
In the United States, there are disparities in access to care for patients with non–small cell lung cancer (NSCLC) on the basis of socioeconomic and racial/ethnic factors.
"In the United States, there are disparities in access to care for patients with non–small cell lung cancer (NSCLC) on the basis of socioeconomic and racial/ethnic factors."
Show evidence (1 reference)
DOI:10.1200/oa.24.00008 SUPPORT Human Clinical
"In the United States, there are disparities in access to care for patients with non–small cell lung cancer (NSCLC) on the basis of socioeconomic and racial/ethnic factors."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Investigating the Relationship Between Exposure to Cadmium and Lung Cancer Risk: A Systematic Review and Meta-analysis
1 finding
Lung cancer is the second most common cancer in the world.
"Lung cancer is the second most common cancer in the world."
Show evidence (1 reference)
"Lung cancer is the second most common cancer in the world."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
A potential central nervous system niche for trastuzumab deruxtecan in patients with HER2-expressing non-small cell lung cancer
1 finding
A potential central nervous system niche for trastuzumab deruxtecan in patients with HER2-expressing non-small cell lung cancer
"A potential central nervous system niche for trastuzumab deruxtecan in patients with HER2-expressing non-small cell lung cancer"
Adagrasib in the Treatment of KRAS p.G12C Positive Advanced NSCLC: Design, Development and Place in Therapy
1 finding
Adagrasib in the Treatment of KRAS p.G12C Positive Advanced NSCLC: Design, Development and Place in Therapy
"Adagrasib in the Treatment of KRAS p.G12C Positive Advanced NSCLC: Design, Development and Place in Therapy"
Screening for lung cancer: 2023 guideline update from the American Cancer Society
1 finding
Lung cancer is the leading cause of mortality and person‐years of life lost from cancer among US men and women.
"Lung cancer is the leading cause of mortality and person‐years of life lost from cancer among US men and women."
Show evidence (1 reference)
DOI:10.3322/caac.21811 SUPPORT Other
"Lung cancer is the leading cause of mortality and person‐years of life lost from cancer among US men and women."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Non-small cell lung cancer with MET amplification: review of epidemiology, associated disease characteristics, testing procedures, burden, and treatments
1 finding
Mesenchymal-epidermal transition factor gene amplification (METamp) is being investigated as a therapeutic target in advanced non-small cell lung cancer (NSCLC).
"Mesenchymal-epidermal transition factor gene amplification (METamp) is being investigated as a therapeutic target in advanced non-small cell lung cancer (NSCLC)."
Show evidence (1 reference)
DOI:10.3389/fonc.2023.1241402 SUPPORT Human Clinical
"Mesenchymal-epidermal transition factor gene amplification (METamp) is being investigated as a therapeutic target in advanced non-small cell lung cancer (NSCLC)."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Mechanisms of resistance to KRASG12C inhibitors in KRASG12C-mutated non-small cell lung cancer
1 finding
The KRAS protein, a product of the KRAS gene (V-ki-ras2 Kirsten rat sarcoma viral oncogene homolog), functions as a small GTPase that alternates between an active GTP-bound state (KRAS(ON)) and an inactive GDP-bound state (KRAS(OFF)).
"The KRAS protein, a product of the KRAS gene (V-ki-ras2 Kirsten rat sarcoma viral oncogene homolog), functions as a small GTPase that alternates between an active GTP-bound state (KRAS(ON)) and an inactive GDP-bound state (KRAS(OFF))."
Show evidence (1 reference)
DOI:10.3389/fonc.2024.1328728 SUPPORT Human Clinical
"The KRAS protein, a product of the KRAS gene (V-ki-ras2 Kirsten rat sarcoma viral oncogene homolog), functions as a small GTPase that alternates between an active GTP-bound state (KRAS(ON)) and an inactive GDP-bound state (KRAS(OFF))."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Real-world treatment patterns, biomarker testing, and clinical outcomes of metastatic non-small cell lung cancer patients in the immunotherapy era
1 finding
Treatment for first-line (1L) metastatic non-small cell cancer (mNSCLC) changed with the introduction of immunotherapy.
"Treatment for first-line (1L) metastatic non-small cell cancer (mNSCLC) changed with the introduction of immunotherapy."
Show evidence (1 reference)
DOI:10.3389/fonc.2024.1442909 SUPPORT Human Clinical
"Treatment for first-line (1L) metastatic non-small cell cancer (mNSCLC) changed with the introduction of immunotherapy."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
HER2-Altered Non-Small Cell Lung Cancer: A Journey from Current Approaches to Emerging Strategies
1 finding
For patients diagnosed with advanced HER2-altered non-small cell lung cancer (NSCLC), the current standard of care is represented by a platinum-pemetrexed-based chemotherapy, eventually in combination with immunotherapy.
"For patients diagnosed with advanced HER2-altered non-small cell lung cancer (NSCLC), the current standard of care is represented by a platinum-pemetrexed-based chemotherapy, eventually in combination with immunotherapy."
Show evidence (1 reference)
DOI:10.3390/cancers16112018 SUPPORT Human Clinical
"For patients diagnosed with advanced HER2-altered non-small cell lung cancer (NSCLC), the current standard of care is represented by a platinum-pemetrexed-based chemotherapy, eventually in combination with immunotherapy."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Site-Specific Response and Resistance Patterns in Patients with Advanced Non-Small-Cell Lung Cancer Treated with First-Line Systemic Therapy
1 finding
Patients with advanced NSCLC have heterogenous responses to immune checkpoint inhibitors (ICIs) with or without chemotherapy.
"Patients with advanced NSCLC have heterogenous responses to immune checkpoint inhibitors (ICIs) with or without chemotherapy."
Show evidence (1 reference)
DOI:10.3390/cancers16112136 SUPPORT Human Clinical
"Patients with advanced NSCLC have heterogenous responses to immune checkpoint inhibitors (ICIs) with or without chemotherapy."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Identification and Application of Emerging Biomarkers in Treatment of Non-Small-Cell Lung Cancer: Systematic Review
1 finding
Non-small-cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, often diagnosed at advanced stages, which diminishes the effective treatment options and survival rates.
"Non-small-cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, often diagnosed at advanced stages, which diminishes the effective treatment options and survival rates."
Show evidence (1 reference)
"Non-small-cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, often diagnosed at advanced stages, which diminishes the effective treatment options and survival rates."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Evolving Precision First-Line Systemic Treatment for Patients with Unresectable Non-Small Cell Lung Cancer
1 finding
First-line systemic therapy for patients with advanced or metastatic non-small cell lung cancer (NSCLC) has rapidly evolved over the past two decades.
"First-line systemic therapy for patients with advanced or metastatic non-small cell lung cancer (NSCLC) has rapidly evolved over the past two decades."
Show evidence (1 reference)
DOI:10.3390/cancers16132350 SUPPORT Computational
"First-line systemic therapy for patients with advanced or metastatic non-small cell lung cancer (NSCLC) has rapidly evolved over the past two decades."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Addressing the unmet need in NSCLC progression with advances in second-line therapeutics
1 finding
Lung cancer is the leading cause of cancer mortality globally, with non-small cell lung cancer (NSCLC) accounting for 85% of cases.
"Lung cancer is the leading cause of cancer mortality globally, with non-small cell lung cancer (NSCLC) accounting for 85% of cases."
Show evidence (1 reference)
DOI:10.37349/etat.2024.00277 SUPPORT Human Clinical
"Lung cancer is the leading cause of cancer mortality globally, with non-small cell lung cancer (NSCLC) accounting for 85% of cases."
Deep research cited this publication as relevant literature for Metastatic NSCLC.
Update in Association between Lung Cancer and Air Pollution
1 finding
A significant portion of newly diagnosed lung cancer cases occurs in populations exposed to air pollution.
"A significant portion of newly diagnosed lung cancer cases occurs in populations exposed to air pollution."
Show evidence (1 reference)
DOI:10.4046/trd.2024.0092 SUPPORT Human Clinical
"A significant portion of newly diagnosed lung cancer cases occurs in populations exposed to air pollution."
Deep research cited this publication as relevant literature for Metastatic NSCLC.

Deep Research

1
Falcon
1. Disease Information
Edison Scientific Literature 75 citations 2026-05-10T01:24:07.978161

1. Disease Information

Overview / definition

mNSCLC refers to non-small cell lung cancers that have spread beyond the lung/hemithorax to distant organs (clinically aligned with stage IV/M1 disease in many registries and studies). Contemporary studies use “metastatic NSCLC,” “advanced NSCLC,” and “stage IV NSCLC” as overlapping operational terms depending on inclusion criteria and data source. (apter2024realworldtreatmentpatterns pages 1-2, uprety2024racialandsocioeconomic pages 3-4, yang2024disparitiesinutilization pages 1-2)

Key identifiers (as available in retrieved sources)

  • Open Targets / EFO: non-small cell lung carcinoma EFO_0003060. (OpenTargets Search: Non-small cell lung carcinoma,Lung adenocarcinoma,Lung squamous cell carcinoma)
  • MONDO: non-small cell squamous lung carcinoma MONDO_0056806 (related histology entity). (OpenTargets Search: Non-small cell lung carcinoma,Lung adenocarcinoma,Lung squamous cell carcinoma)
  • MeSH / ICD-10 / ICD-11 / OMIM / Orphanet: Not found in the retrieved evidence for mNSCLC or stage IV NSCLC; these would typically be obtained from ontology resources (e.g., MeSH browser, ICD-10/11, MONDO) outside the currently retrieved corpus.

Common synonyms

  • Metastatic NSCLC, advanced NSCLC (when metastatic), stage IV NSCLC, M1 NSCLC. (apter2024realworldtreatmentpatterns pages 1-2, uprety2024racialandsocioeconomic pages 3-4, yang2024disparitiesinutilization pages 1-2)

Evidence source types

  • Aggregated disease-level resources: SEER/SEER-Medicare population datasets and national registries (Norway). (hektoen2024realworldevidencefor pages 1-2, uprety2024racialandsocioeconomic pages 3-4)
  • Real-world evidence (RWE): health system cohorts and EMR datasets. (apter2024realworldtreatmentpatterns pages 1-2, hektoen2024realworldevidencefor pages 5-6)
  • Clinical trials: phase 3 biomarker-selected trials (e.g., EGFR-mutant MARIPOSA). (cho2024amivantamabpluslazertinib pages 8-9)

2. Etiology

Primary causal factors (multifactorial)

NSCLC (and thus mNSCLC) arises through a combination of carcinogen exposures and acquired somatic genomic alterations (driver mutations/fusions), with strong contributions from tobacco smoke and additional environmental/occupational carcinogens.

Tobacco smoking

Tobacco is the dominant risk factor in Western settings; a 2024 review of geographic differences states tobacco accounts for “up to 80–90% of cases” in Western societies. (laguna2024geographicdifferencesin pages 1-3)

Ambient air pollution (particulate matter)

Air pollution is classified as carcinogenic to humans, and long-term PM2.5 exposure shows dose–response associations with lung cancer risk and mortality. A 2024 review reports, for example, AHSMOG-2: a 10 μg/m³ PM2.5 increase associated with HR 1.43 (95% CI 1.03–2.00) for lung cancer. (yoo2024updateinassociation pages 2-3)

Mechanistic plausibility described in the same review includes oxidative stress, inflammation, and DNA damage/mutagenesis pathways induced by PM components (e.g., PAHs, metals) and ROS signaling. (yoo2024updateinassociation pages 2-3)

Occupational carcinogens: cadmium (example with quantitative meta-analysis)

A 2024 systematic review/meta-analysis reported higher cadmium exposure associated with increased lung cancer risk: OR 1.31 (95% CI 1.06–1.62; p=0.024), interpreted as a 31% increase. (farahmandian2024investigatingtherelationship pages 1-2)

Radon

Radon is commonly described as a leading non-tobacco cause (particularly in the US) and has no known safe level; the EPA remediation threshold 4 pCi/L (148 Bq/m³) is cited in a 2024 review. (laguna2024geographicdifferencesin pages 1-3)

Protective factors

Direct protective-factor estimates were not retrieved in the current evidence set. In practice, major protective factors include tobacco cessation and reduction of carcinogen exposures; smoking cessation is emphasized as a key preventive action within screening guidelines. (wolf2024screeningforlung pages 7-7)

Gene–environment interactions

A 2024 review notes associations between exposure patterns and driver distributions: EGFR mutations are more common in never-smokers and some populations, while KRAS G12C is associated with smoking history. (laguna2024geographicdifferencesin pages 1-3)


3. Phenotypes

Clinical presentation (metastatic disease)

mNSCLC can present with pulmonary symptoms (cough, dyspnea), systemic symptoms (weight loss), and/or organ-specific symptoms from metastases. In a SEER-M1 analysis, common metastatic organs vary by histology (see “Anatomical structures affected”). (xie2024distantmetastasispatterns pages 1-2, xie2024distantmetastasispatterns pages 2-3)

Metastasis-associated phenotypes & HPO term suggestions

Below are common metastasis-related phenotype groupings relevant to mNSCLC knowledge-base annotation. Frequencies are not uniformly available across all studies in the retrieved evidence; where available, they are provided.

  1. Bone metastasis / skeletal complications
  2. Evidence of frequency/pattern: In SEER M1 lung cancer, bone metastasis was most common in lung adenocarcinoma (ADC), squamous (SCC), adenosquamous (ASC), and large cell carcinoma (LCC) (e.g., ADC bone metastasis 35.15%). (xie2024distantmetastasispatterns pages 2-3)
  3. EGFR-mutant cohort: vertebrae (76.3%) and pelvis (60.9%) were frequent bone sites. (tanaka2024femoralbonemetastasis pages 1-3)
  4. Suggested HPO: HP:0002652 (Skeletal metastasis), HP:0002653 (Bone pain), HP:0012655 (Pathologic fracture).

  5. Brain metastasis / neurologic manifestations

  6. Epidemiology note: brain metastases present in a meaningful subset; a real-world US cohort reported brain metastases present in 22.9% of advanced NSCLC patients at treatment initiation. (hektoen2024realworldevidencefor pages 3-5)
  7. Suggested HPO: HP:0002506 (Brain metastasis), HP:0001288 (Gait disturbance), HP:0001250 (Seizures), HP:0002315 (Headache).

  8. Liver metastasis / hepatic dysfunction

  9. In SEER, liver metastases were particularly common in SCLC rather than NSCLC, but liver involvement in advanced NSCLC is prognostically important (see prognosis section). (xie2024distantmetastasispatterns pages 2-3, brown2024sitespecificresponseand pages 11-12)
  10. Suggested HPO: HP:0001410 (Hepatomegaly), HP:0001397 (Hepatic metastasis), HP:0002904 (Elevated hepatic transaminases) (laboratory abnormality).

  11. Adrenal metastasis

  12. Mentioned as a common extrathoracic site in advanced NSCLC cohorts. (brown2024sitespecificresponseand pages 1-2)
  13. Suggested HPO: HP:0031909 (Adrenal metastasis) (if available in HPO; otherwise annotate as adrenal mass + cancer).

Quality of life impact

Direct QoL instrument data (e.g., EQ-5D, SF-36) specific to metastatic NSCLC were not retrieved in the current evidence set; however, the metastatic burden and organ involvement (bone/brain) are consistently associated with poorer survival and often correlate with functional decline. (brown2024sitespecificresponseand pages 11-12, tanaka2024femoralbonemetastasis pages 1-3)


4. Genetic / Molecular Information

Core concept: actionable somatic drivers and biomarkers

Modern mNSCLC management is biomarker-driven: actionable genomic alterations and immune biomarkers (PD-L1, sometimes TMB) are used to select targeted therapy or immunotherapy.

A 2024 review lists actionable first-line targets in unresectable/advanced/metastatic NSCLC including EGFR, ALK, ROS1, RET, NTRK1/2/3 fusions, BRAF V600E, and MET exon 14 skipping; immune selection includes PD-L1 TPS ≥50% for PD-1/PD-L1 monotherapy when no sensitizing EGFR/ALK alterations are present. (li2024evolvingprecisionfirstline pages 1-2)

A separate 2024 review emphasizes broad panels and includes additional emerging targets such as ERBB2 (HER2) and KRAS G12C. (li2024evolvingprecisionfirstline pages 4-6)

Suggested genes (HGNC symbols)

EGFR, KRAS, ALK, ROS1, MET, RET, ERBB2, BRAF, NTRK1, NTRK2, NTRK3, TP53, STK11, KEAP1.

Pathogenic variants (somatic)

  • EGFR activating variants: exon 19 deletions, L858R (used as eligibility in EGFR-mutant metastatic trials). (cho2024amivantamabpluslazertinib pages 1-4)
  • KRAS G12C: occurs in ~13% of lung adenocarcinomas; KRAS mutations overall ~25–30% of NSCLC; G12C ~40% of KRAS-mutated NSCLC. (chour2024mechanismsofresistance pages 1-2, warnecke2024adagrasibinthe pages 1-2)
  • ERBB2 (HER2): HER2 mutations occur in ~4% of NSCLC; common exon 20 insertion A775_G776insYVMA ~34% of HER2 mutations. (ferrari2024her2alterednonsmallcell pages 1-2)

Molecular biomarkers (immune)

  • PD-L1 TPS ≥50%: used to select PD-1/PD-L1 monotherapy as standard of care in biomarker-driven algorithms. (li2024evolvingprecisionfirstline pages 1-2)
  • A large combined trial + real-world analysis found tumor PD-L1 ≥50% specifically associated with CPI response, and TMB ≥10.44 mut/Mb associated with durable CPI response; combined high TMB + high PD-L1 was the strongest predictor reported (OR 0.04). (hektoen2024realworldevidencefor pages 3-5, cho2024amivantamabpluslazertinib pages 7-8)

Resistance mechanisms (selected examples)

  • KRAS G12C inhibitors: resistance frequently acquired; includes on-target KRAS mutations affecting inhibitor binding and off-target bypass via NRAS, BRAF, RET activation, PTEN loss, EMT, and histologic transformation. (chour2024mechanismsofresistance pages 1-2)

Epigenetic / chromosomal abnormalities

Specific epigenetic or chromosomal-abnormality datasets were not retrieved in the current evidence set.


5. Environmental Information

Environmental and lifestyle factors

  • Ambient PM2.5 exposure shows increased risk and mortality with mechanistic links to ROS/oxidative stress and DNA damage. (yoo2024updateinassociation pages 2-3)
  • Cadmium exposure is associated with increased risk (meta-analysis OR 1.31). (farahmandian2024investigatingtherelationship pages 1-2)
  • Radon exposure is emphasized as a major residential risk and policy target (EPA action level 4 pCi/L). (laguna2024geographicdifferencesin pages 1-3)

Infectious agents

No specific infectious causal agents for NSCLC were retrieved in the current evidence set.


6. Mechanism / Pathophysiology

Core oncogenic signaling pathways

  • EGFR pathway and downstream MAPK/PI3K signaling drive EGFR-mutant NSCLC; EGFR-directed therapies improve outcomes in biomarker-selected metastatic disease (see Treatments). (cho2024amivantamabpluslazertinib pages 1-4)
  • KRAS is a small GTPase cycling between GDP/GTP states; KRAS G12C inhibitors covalently target the inactive GDP-bound state and suppress downstream MAPK and PI3K signaling. (chour2024mechanismsofresistance pages 1-2)

Tumor microenvironment (TME) and immune evasion

Organ-specific microenvironments influence immunotherapy response: bone and liver metastases are associated with lower response and worse outcomes, suggesting site-specific immune resistance. (brown2024sitespecificresponseand pages 11-12, brown2024sitespecificresponseand pages 1-2)

Mechanistic chain (example: KRAS G12C targeted therapy)

1) KRAS G12C mutation → accumulation of KRAS(GDP)-bound fraction amenable to covalent inhibitors → initial MAPK/PI3K suppression → tumor response. (chour2024mechanismsofresistance pages 1-2) 2) Adaptive feedback and bypass signaling (e.g., NRAS/BRAF/RET activation; PTEN loss) and phenotypic shifts (EMT, transformation) → acquired resistance and progression. (chour2024mechanismsofresistance pages 1-2)

Suggested GO biological process terms (illustrative)

  • GO:0007169 (transmembrane receptor protein tyrosine kinase signaling pathway)
  • GO:0000165 (MAPK cascade)
  • GO:0008285 (negative regulation of cell population proliferation) / dysregulation in cancer
  • GO:0042110 (T cell activation) (immune context)

Suggested Cell Ontology (CL) terms (illustrative)

  • CL:0000182 (T cell)
  • CL:0000236 (B cell)
  • CL:0000624 (CD4-positive, alpha-beta T cell)
  • CL:0000625 (CD8-positive, alpha-beta T cell)
  • CL:0000451 (dendritic cell)
  • CL:0000235 (macrophage)

(These ontology suggestions are generic to tumor/immune interactions; the retrieved evidence supports immune and microenvironment involvement but does not enumerate CL/GO terms explicitly.) (yoo2024updateinassociation pages 2-3, brown2024sitespecificresponseand pages 11-12)


7. Anatomical Structures Affected

Organ-level sites (metastases)

A SEER-based analysis (2010–2019; 77,827 M1 cases) found histology-specific metastatic patterns: - Bone: most common in ADC, SCC, ASC, LCC (e.g., ADC 35.15%). (xie2024distantmetastasispatterns pages 2-3) - Brain: particularly common in LCNEC. (xie2024distantmetastasispatterns pages 1-2) - Liver: particularly common in SCLC (included here for lung cancer context). (xie2024distantmetastasispatterns pages 2-3) - Lung-to-lung (intrapulmonary): common in carcinoid tumors and SCC. (xie2024distantmetastasispatterns pages 1-2)

UBERON term suggestions (common sites)

  • Lung: UBERON:0002048
  • Bone tissue: UBERON:0002481
  • Brain: UBERON:0000955
  • Liver: UBERON:0002107
  • Adrenal gland: UBERON:0002369

8. Temporal Development

Onset and progression

Most lung cancer is diagnosed at advanced stages in many populations; a review notes that “most cases are diagnosed in advanced stages,” emphasizing prevention/early diagnosis importance. (laguna2024geographicdifferencesin pages 1-3)

Disease stages

mNSCLC corresponds to metastatic (M1) disease; SEER data indicate substantial proportion present with metastasis at diagnosis (e.g., 41.22% M1 lung cancers with distant metastasis at presentation in one SEER analysis). (xie2024distantmetastasispatterns pages 1-2)


9. Inheritance and Population

Epidemiology (selected, recent population-based data)

  • SEER-Medicare metastatic NSCLC (2015–2019; n=17,134): overall median OS 7 months, 1-year OS 34%, 2-year OS 21%. (uprety2024racialandsocioeconomic pages 3-4)
  • ICI utilization: ~39% received an immune checkpoint inhibitor; utilization increased from 21.9% (2015) to 55.4% (2019). (uprety2024racialandsocioeconomic pages 3-4)
  • Survival disparity: 2-year OS from diagnosis differed by race (White 22%, Asian 23%, Black 15%, Hispanic 17%); among ICI recipients, racial differences in survival were not statistically significant, suggesting access/utilization drives disparity. (uprety2024racialandsocioeconomic pages 1-2)

Genetic etiology and inheritance

mNSCLC is primarily driven by somatic alterations; a 2024 review notes pathogenic germline variants in high/moderate penetrance genes in 4.3% of a cohort (germline susceptibility signal, not typically a Mendelian inheritance pattern for mNSCLC). (laguna2024geographicdifferencesin pages 1-3)


10. Diagnostics

Tissue diagnosis and immunohistochemistry

Histologic classification in small biopsies often uses IHC panels: TTF-1 / napsin A (adenocarcinoma) and p40 / p63 (squamous). (li2024evolvingprecisionfirstline pages 2-4)

Molecular testing (tissue NGS and fusions)

CAP/IASLC/AMP guidance (as summarized in a 2024 review) recommends testing all advanced lung cancers for sensitizing EGFR and ALK, with expansion to ROS1 and BRAF and then RET, MET, ERBB2, KRAS if earlier drivers are negative; NGS is emphasized for SNVs/CNVs/fusions and high yield. (li2024evolvingprecisionfirstline pages 2-4)

RNA-based NGS can improve fusion detection (ALK/ROS1/RET/NTRK). (li2024evolvingprecisionfirstline pages 4-6)

Immune biomarker testing

PD-L1 IHC is used for PD-1/PD-L1 selection; PD-L1 TPS ≥50% is used as a key threshold for monotherapy selection in biomarker algorithms. (li2024evolvingprecisionfirstline pages 1-2)

Liquid biopsy / ctDNA

When tissue is insufficient or re-biopsy may delay care, plasma ctDNA can accelerate profiling and capture alterations from primary and metastatic sites. (li2024evolvingprecisionfirstline pages 4-6)

ctDNA is also used for resistance monitoring (e.g., EGFR T790M) and treatment decision support. (restrepo2024identificationandapplication pages 15-16)

MET amplification testing thresholds (example of concrete numeric definitions)

A 2024 review of MET amplification reports: - Primary METamp prevalence ~4.8%; secondary (post-EGFR-TKI) METamp ~15%. (yang2024nonsmallcelllung pages 1-2) - Definition variability: FISH ratios (MET:CEP7 ≥1.8 to ≥3.0) or gene copy number (GCN ≥5 to ≥10); NGS tissue thresholds (GCN ≥6); liquid biopsy thresholds reported (MET copy number ≥2.1 to >5). (yang2024nonsmallcelllung pages 1-2) - NCCN notes copy number >10 consistent with high-level MET amplification (NGS). (yang2024nonsmallcelllung pages 3-5)

Differential diagnosis

Specific differential-diagnosis algorithms were not retrieved in the current evidence set.


11. Outcome / Prognosis

Survival statistics (recent)

  • Population-based metastatic NSCLC (SEER-Medicare 2015–2019): median OS 7 months; 2-year OS 21%. (uprety2024racialandsocioeconomic pages 3-4)
  • Real-world first-line immunotherapy era (Norway 2012–2021): median OS improved from 8.0 months (historical chemo) to 13.8 months (pembrolizumab monotherapy) and 12.8 months (pembrolizumab + chemotherapy). (hektoen2024realworldevidencefor pages 1-2)

Prognostic factors (metastatic site)

  • Bone metastases are repeatedly associated with worse outcomes.
  • In a 2024 cohort, bone metastases were linked to shorter OS (median 10 vs 21 months; HR 1.95) and shorter PFS (HR 1.70). (brown2024sitespecificresponseand pages 11-12)
  • A multicenter immunotherapy cohort found presence of bone metastases independently worsened OS (HR 1.26). (xie2024distantmetastasispatterns pages 2-3)

12. Treatment

Current first-line paradigms (conceptual)

For metastatic NSCLC without sensitizing oncogenic drivers, ICIs as monotherapy (PD-L1-high) or chemoimmunotherapy (PD-L1 low/negative) are standard approaches; for biomarker-defined drivers (EGFR/ALK/ROS1/RET/MET/BRAF/etc.) targeted therapies are prioritized. (li2024evolvingprecisionfirstline pages 1-2)

Recent developments / latest research (prioritizing 2023–2024)

EGFR-mutant metastatic NSCLC: MARIPOSA (practice-changing 2024)

MARIPOSA (NEJM, Oct 2024) compared amivantamab + lazertinib vs osimertinib first-line in EGFR exon19del/L858R advanced/metastatic NSCLC. - Efficacy: median PFS 23.7 vs 16.6 months, HR 0.70 (95% CI 0.58–0.85; P<0.001). ORR 86% vs 85%; median DoR 25.8 vs 16.8 months; interim OS HR 0.80 (95% CI 0.61–1.05). (cho2024amivantamabpluslazertinib pages 8-9, cho2024amivantamabpluslazertinib pages 9-11) - Safety: grade ≥3 AEs 75% vs 43%; infusion reactions 63%; venous thromboembolism 37% vs 9%; AE-related discontinuation 35% vs 14%. (cho2024amivantamabpluslazertinib pages 9-11)

Figure evidence: Kaplan–Meier PFS separation and hazard ratio are shown in the extracted figure. (cho2024amivantamabpluslazertinib media ee6afa38)

Abstract quote:The median progression-free survival was significantly longer in the amivantamab-lazertinib group than in the osimertinib group (23.7 vs. 16.6 months; hazard ratio … 0.70 …; P<0.001).” (cho2024amivantamabpluslazertinib pages 1-4)

Suggested MAXO terms (illustrative): tyrosine kinase inhibitor therapy; monoclonal antibody therapy; combination antineoplastic therapy.

KRAS G12C metastatic NSCLC (targeted therapy; resistance-focused 2024 synthesis)

  • Frequency: KRAS G12C is found in ~13% of lung adenocarcinomas. (chour2024mechanismsofresistance pages 1-2)
  • Phase 3 evidence: in CodeBreaK 200, sotorasib vs docetaxel improved PFS (5.6 vs 4.5 months, HR 0.66) and ORR (28.1% vs 13.2%) but not OS (10.6 vs 11.3 months). (warnecke2024adagrasibinthe pages 4-5)
  • Adagrasib CNS activity (summary): intracranial ORR 42% with intracranial PFS 5.4 months; systemic ORR 30%, PFS 5.3 months. (warnecke2024adagrasibinthe pages 4-5)
  • Mechanisms of resistance: bypass activation (NRAS/BRAF/RET), PTEN loss, EMT, histologic transformation; on-target KRAS mutations preventing binding. (chour2024mechanismsofresistance pages 1-2)

Suggested MAXO: targeted small molecule therapy; molecularly targeted therapy; tumor sequencing-guided therapy.

HER2 (ERBB2)-mutant metastatic NSCLC: ADCs (2024 state-of-the-art)

  • Frequency: HER2 mutations ~4% of NSCLC; common exon 20 insertion A775_G776insYVMA ~34% of HER2 mutations. (ferrari2024her2alterednonsmallcell pages 1-2)
  • Trastuzumab deruxtecan (T-DXd): DESTINY-Lung01 (HER2-mutant; N=91) ORR ~55%, median PFS 8.2 months, median OS 17.8–18.6 months. (lazaratos2024apotentialcentral pages 1-2, wang2024addressingtheunmet pages 3-5)
  • DESTINY-Lung02 (dose cohorts): ORR around 53.8% vs 42.9% (5.4 vs 6.4 mg/kg) in one summary. (wang2024addressingtheunmet pages 3-5)
  • Intracranial relevance: reviews emphasize CNS activity and report subgroup outcomes in patients with stable brain metastases. (lazaratos2024apotentialcentral pages 2-4, ferrari2024her2alterednonsmallcell pages 1-2)

Suggested MAXO: antibody–drug conjugate therapy; HER2-targeted therapy.

Immunotherapy real-world implementation (effectiveness)

  • In a nationwide Norwegian cohort, first-line pembrolizumab OS improved versus historical chemotherapy (median OS 13.8 months for pembrolizumab monotherapy and 12.8 months for pembrolizumab+chemo vs 8.0 months pre-ICI). (hektoen2024realworldevidencefor pages 1-2)
  • In an Israeli health-system cohort (mNSCLC), median real-world OS from first-line was 12.5 months for PD-1 monotherapy and 14.8 months for PD-1 + chemotherapy among nonsquamous patients without EGFR/ALK/ROS1; outcomes were better in ECOG 0–1 and PD-L1 ≥50% (e.g., median rwOS 25.1 months for ECOG 0–1 with monotherapy). (apter2024realworldtreatmentpatterns pages 1-2)

Expert analysis in authoritative sources: Real-world cohorts repeatedly observe lower OS than pivotal trials but preservation of the relative benefit compared with chemotherapy, supporting generalizability while highlighting trial-to-practice gaps (age, ECOG, comorbidities). (hektoen2024realworldevidencefor pages 1-2)


13. Prevention

Primary prevention

  • Reduce tobacco exposure and implement smoking-cessation interventions; ACS guideline emphasizes cessation counseling and connection to resources for current smokers. (wolf2024screeningforlung pages 7-7)
  • Reduce environmental/occupational exposures (PM2.5 reduction, radon mitigation, carcinogen control) supported by risk estimates and mechanistic plausibility. (yoo2024updateinassociation pages 2-3, laguna2024geographicdifferencesin pages 1-3)

Secondary prevention: Screening (ACS 2023 update; published Nov 2024)

ACS recommends annual LDCT lung cancer screening for asymptomatic individuals: - Age: 50–80 years - Smoking: ≥20 pack-years - Smoking status: current or former smokers; years-since-quitting is not used as an eligibility criterion. (wolf2024screeningforlung pages 2-3, wolf2024screeningforlung pages 7-7)

Abstract quote:The ACS recommends annual LCS with low‐dose computed tomography for asymptomatic individuals aged 50–80 years who currently smoke or formerly smoked and have a ≥20 pack‐year smoking history.” (wolf2024screeningforlung pages 1-2)


14. Other Species / Natural Disease

Direct comparative pathology or naturally occurring non-human mNSCLC content was not retrieved in the current evidence set.


15. Model Organisms / Model Systems

Patient-derived xenografts (PDX)

  • A 2024 study established 13 NSCLC-PDXs from 62 patients, reporting preservation of histology/genetics and concordant chemotherapy responses between PDX and matched patients; an osimertinib-resistant PDX implicated DUSP6 M62I and MAPK-ERK overactivation, with trametinib slowing resistant tumor growth. (wang2024utilityofpatientderived pages 1-2)
  • TRACERx multi-region analysis generated 48 PDX models from 22 patients, showing multi-region sampling improves engraftment but individual PDXs often represent a single subclone (genomic bottleneck) and do not fully recapitulate intratumor heterogeneity. (hynds2024representationofgenomic pages 1-2)

Patient-derived organoids (PDOs)

  • Pleural effusion-derived organoids can be used for rapid therapy-response prediction in advanced EGFR-mutant NSCLC: drug-response evaluation within ~1 week and clinically aligned response classification within 10 days (validated in 14 patients). (lee2024predictionoftki pages 1-2)
  • A 2024 Cell Reports Medicine paper describes using LUAD PDOs to model metastases and test resistance mechanisms (e.g., KRASG12C PDOs treated with sotorasib) and notes limitations of PDXs for metastasis biology (rare metastasis in LUAD PDX). (liu2024modelinglungadenocarcinoma pages 1-4)

Evidence tables (for knowledge-base population)

Entity Definition / scope Synonyms / alternative names MONDO MeSH ICD Notes / evidence
Metastatic non-small cell lung cancer Advanced NSCLC with distant metastatic spread; often operationally aligned with stage IV disease in clinical studies and population datasets mNSCLC; metastatic NSCLC; advanced NSCLC (when metastatic cohort) Specific MONDO/MeSH/ICD identifier for the metastatic-stage entity was not found in retrieved evidence; studies explicitly use “metastatic NSCLC” terminology (apter2024realworldtreatmentpatterns pages 1-2, uprety2024racialandsocioeconomic pages 3-4)
Stage IV non-small cell lung cancer AJCC/registry stage IV NSCLC; commonly used as a proxy for metastatic disease in epidemiologic and treatment studies stage IV NSCLC; metastatic stage NSCLC Used in SEER/SEER-Medicare analyses and real-world treatment datasets; exact ICD/MeSH/MONDO code not reported in retrieved evidence (yang2024disparitiesinutilization pages 1-2, yang2024disparitiesinutilization pages 2-3)
Non-small cell lung cancer Major lung cancer class comprising ~80%–90% of lung cancers; umbrella category including adenocarcinoma and squamous carcinoma NSCLC; non-small-cell lung cancer; non-small cell lung carcinoma Disease-level identifiers were not reported in retrieved evidence; Open Targets lists non-small cell lung carcinoma as EFO_0003060 (not MONDO) (apter2024realworldtreatmentpatterns pages 1-2, OpenTargets Search: Non-small cell lung carcinoma,Lung adenocarcinoma,Lung squamous cell carcinoma)
Non-squamous NSCLC / lung adenocarcinoma predominant mNSCLC Common metastatic NSCLC subtype in immunotherapy-era cohorts NSQ NSCLC; adenocarcinoma-predominant NSCLC In one mNSCLC real-world cohort, 85% had adenocarcinoma histology; exact ontology identifiers not reported in retrieved evidence (apter2024realworldtreatmentpatterns pages 1-2)
Squamous NSCLC Squamous histologic subtype of NSCLC squamous cell NSCLC; squamous cell carcinoma of lung (NSCLC context) MONDO_0056806 (for non-small cell squamous lung carcinoma in Open Targets context) Histology-specific related entity rather than the target disease; included because many metastatic cohorts stratify by histology (OpenTargets Search: Non-small cell lung carcinoma,Lung adenocarcinoma,Lung squamous cell carcinoma, apter2024realworldtreatmentpatterns pages 1-2)
Setting / population Biomarker Intervention Comparator Key outcomes (PFS / OS / ORR) Notable safety Publication (year, journal) URL
Previously untreated EGFR-mutated locally advanced/metastatic NSCLC (MARIPOSA) EGFR exon 19 deletion or L858R Amivantamab + lazertinib Osimertinib Median PFS 23.7 vs 16.6 mo; HR 0.70 (95% CI 0.58–0.85); ORR 86% vs 85%; median DoR 25.8 vs 16.8 mo; interim OS HR 0.80 (95% CI 0.61–1.05) (cho2024amivantamabpluslazertinib pages 8-9, cho2024amivantamabpluslazertinib pages 1-4, cho2024amivantamabpluslazertinib pages 9-11) Grade ≥3 AEs 75% vs 43%; infusion-related reactions 63%; VTE 37% vs 9%; discontinuation due to AEs 35% vs 14%; discontinuation of all agents due to treatment-related AEs 10% vs 3% (cho2024amivantamabpluslazertinib pages 11-12, cho2024amivantamabpluslazertinib pages 9-11, cho2024amivantamabpluslazertinib media ee6afa38) Cho et al., 2024, New England Journal of Medicine https://doi.org/10.1056/NEJMoa2403614
Nationwide Norway real-world advanced/metastatic NSCLC initiating 1L systemic therapy, 2012–2021 No targetable mutation required; pembrolizumab-treated cohorts reflect standard clinical selection Pembrolizumab monotherapy or pembrolizumab + chemotherapy Historical pre-ICI platinum chemotherapy Median OS: pembrolizumab mono 13.8 mo; pembrolizumab + chemo 12.8 mo; historical chemo 8.0 mo; 2-year OS increased to ~35% (mono) and ~31% (combo) vs ~19% pre-ICI (hektoen2024realworldevidencefor pages 5-6, hektoen2024realworldevidencefor pages 7-8, hektoen2024realworldevidencefor pages 1-2) Real-world patients were older and broader than KEYNOTE trial populations; specific PFS not reported in retrieved excerpts (hektoen2024realworldevidencefor pages 5-6, hektoen2024realworldevidencefor pages 1-2) Hektoen et al., 2024, British Journal of Cancer https://doi.org/10.1038/s41416-024-02895-1
SEER-Medicare metastatic NSCLC, diagnosed 2015–2019 (n=17,134) Population-level; not biomarker-selected Immune checkpoint inhibitor exposure (any approved ICI claim) No ICI / population benchmark ICI utilization 38.7% (~39%); overall median OS 7 mo; 1-year OS 34%; 2-year OS 21%; 2-year OS from ICI initiation 30% vs 11% without ICI (uprety2024racialandsocioeconomic pages 3-4, uprety2024racialandsocioeconomic pages 1-2, uprety2024racialandsocioeconomic pages 2-3) Main issue highlighted was access disparity rather than toxicity; lower ICI use in Black, lower-SES, rural, and dual-eligible groups (uprety2024racialandsocioeconomic pages 3-4, uprety2024racialandsocioeconomic pages 1-2) Uprety et al., 2024, JNCI Journal of the National Cancer Institute https://doi.org/10.1093/jnci/djae118
Previously treated KRAS G12C-mutated advanced/metastatic NSCLC (phase III CodeBreaK 200) KRAS G12C Sotorasib Docetaxel Median PFS 5.6 vs 4.5 mo; HR 0.66; ORR 28.1% vs 13.2%; median OS 10.6 vs 11.3 mo (not statistically different) (chour2024mechanismsofresistance pages 1-2, warnecke2024adagrasibinthe pages 4-5) TRAEs common; pooled meta-analysis suggests any-grade trAEs 79.3% and grade ≥3 trAEs 24.4% across KRAS G12C inhibitors; sotorasib had better pooled safety than adagrasib (warnecke2024adagrasibinthe pages 4-5, dang2024efficacyandtoxicity pages 1-2) Summarized in Warnecke & Nagasaka, 2024, Drug Design, Development and Therapy; Chour et al., 2024, Frontiers in Oncology https://doi.org/10.2147/DDDT.S466217
KRAS G12C-mutated advanced/metastatic NSCLC with CNS-active/refractory disease evidence (KRYSTAL program summaries) KRAS G12C Adagrasib Mostly single-arm / some docetaxel comparison in KRYSTAL-12 intracranial subset Intracranial ORR 42% (95% CI 20–66.5%); intracranial PFS 5.4 mo; intracranial DoR 12.7 mo; systemic ORR 30%; systemic PFS 5.3 mo; KRYSTAL-12 intracranial ORR 40% vs 11% with docetaxel (warnecke2024adagrasibinthe pages 4-5) Adagrasib generally associated with more toxicity than sotorasib in pooled analyses; resistance common via on-target/off-target bypass mechanisms (chour2024mechanismsofresistance pages 1-2, dang2024efficacyandtoxicity pages 1-2) Warnecke & Nagasaka, 2024, Drug Design, Development and Therapy https://doi.org/10.2147/DDDT.S466217
Pretreated HER2-mutant metastatic NSCLC (DESTINY-Lung01) HER2 / ERBB2 mutation Trastuzumab deruxtecan (T-DXd) 6.4 mg/kg Single-arm ORR 54.9–55%; median PFS 8.2 mo; median OS 17.8–18.6 mo; median DoR 10.6 mo; DCR 92% (lazaratos2024apotentialcentral pages 1-2, lazaratos2024apotentialcentral pages 2-4, wang2024addressingtheunmet pages 3-5) Interstitial lung disease is a major toxicity concern; pooled/summary estimates ~11.6% ILD overall with grade 5 events reported in reviews (lazaratos2024apotentialcentral pages 2-4) Summarized in Ferrari et al., 2024, Cancers; Wang et al., 2024, Exploration of Targeted Anti-tumor Therapy https://doi.org/10.3390/cancers16112018
Pretreated HER2-mutant advanced/metastatic NSCLC (DESTINY-Lung02) HER2 / ERBB2 mutation Trastuzumab deruxtecan 5.4 mg/kg (approved dose) 6.4 mg/kg cohort / non-comparative dose evaluation ORR 53.8% vs 42.9% (5.4 vs 6.4 mg/kg) in one summary; another review reports approved-dose ORR 49.0%, median DoR 16.8 mo, median PFS 9.9 mo (wang2024addressingtheunmet pages 3-5, li2024shra1811(antibodydrugconjugate) pages 1-2) ILD/pneumonitis monitoring remains essential; intracranial activity also noted in reviews and brain-metastasis subgroups (lazaratos2024apotentialcentral pages 2-4, ferrari2024her2alterednonsmallcell pages 1-2) Li et al., 2024, Signal Transduction and Targeted Therapy; Ferrari et al., 2024, Cancers https://doi.org/10.1038/s41392-024-01897-y

Table: This artifact provides two compact tables: one for disease naming/identifier coverage in the retrieved evidence, and one for pivotal 2024 metastatic NSCLC efficacy and safety figures across major treatment settings. It is useful for quickly mapping terminology and comparing contemporary clinical outcomes across targeted therapy, immunotherapy, and population-level datasets.


Notes on evidence limitations in this run

1) Several requested ontology identifiers (ICD-10/11, MeSH, metastatic-stage MONDO) were not present in the retrieved full-text corpus and should be added from ontology resources. 2) Some sections (QoL instruments, detailed differential diagnosis, epigenetics) require additional targeted retrieval beyond the current evidence set.

References

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  36. (wolf2024screeningforlung pages 2-3): Andrew M. D. Wolf, Kevin C. Oeffinger, Tina Ya‐Chen Shih, Louise C. Walter, Timothy R. Church, Elizabeth T. H. Fontham, Elena B. Elkin, Ruth D. Etzioni, Carmen E. Guerra, Rebecca B. Perkins, Karli K. Kondo, Tyler B. Kratzer, Deana Manassaram‐Baptiste, William L. Dahut, and Robert A. Smith. Screening for lung cancer: 2023 guideline update from the american cancer society. CA: A Cancer Journal for Clinicians, 74:50-81, Nov 2024. URL: https://doi.org/10.3322/caac.21811, doi:10.3322/caac.21811. This article has 425 citations and is from a domain leading peer-reviewed journal.

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