Better Selection Model for EML4-ALK Fusion Gene Test in Patients with Non-Small-Cell Lung Cancer 57
sex [15].
Smoking: Our data collection was not comprehensive
enough to determine smoking habits differences among
groups. Smoking exposure data was collected from 76 of
125 patients (60.8%), but no statistically significant dif-
ferences were found among the groups. Several studies
showed that the EML4-ALK fusion was more frequent in
never smokers or light smokers [8-10,16-17]. In the
Koivunen et al. study, the EML4-ALK fusion was de-
tected significantly more frequently in patients with lim-
ited smoking history (<10 pack-years) compared with
tumors from smokers [16]. In the Shaw et al. study [9],
patients who were positive for EML4-ALK fusion were
more likely to be never smokers or light smokers, com-
pared with patients in the wild-type cohort (p < 0.001).
Also in the Wong et al. study, the EML4-ALK fusion
was significantly higher in non-smokers [8]. In the Ta-
kahashi et al. study, the EML4-ALK fusion was pre-
dominantly found in non-smokers or light smokers [10].
Other studies found no association between EML4-ALK
fusion and smoking hab i ts [7,15] .
5. Conclusion
EML4-ALK fusion in selected patients in Israel with
non-squamous cell lung carcinoma, in whom the EGFR
mutation test was negative, was found to be more fre-
quent (15.2%) than expected when no selection was in-
troduced. In this group, the ALK fusion was significantly
more prevalent in younger men. Based on this study and
on published literature, in order to avoid unnecessary
ALK fusion tests, we recommend selecting patients with
non-squamous cell lung carcinoma in whom both the
EGFR and the KRAS mutations are negative.
6. Acknowledgements
The authors thank Oncotest-TEVA Pharmaceutical in-
dustries LTD. for their assistance in data management.
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