SADA-10 HIGH-YIELD MOLECULAR PROGNOSTICATION IN SOLID TUMORS FOR THE PRACTICING SPINE SURGEON
Andrew Hardigan, Rafael De La Garza Ramos, Chetan Bettegowda, Ori Barzilai, Patel Shreyaskumar, Michael G Fehlings, Ilya Laufer, Arjun Sahgal, Laurence D Rhines, Jeremy Reynolds, Aron Lazary, Alessandro Gasbarrini, Nicholas Dea, Jorrit-Jan Verlaan, Patricia Zadnik Sullivan, Ziya L Gokaslan, Charles Fisher, Stefano Boriani, John Shin, Francis Hornicek, Michael Weber, Matthew Goodwin, Rapaële Charest-Morin, , C Rory GoodwinAbstract
Introduction
As oncologic care continues to evolve with the advent of targeted therapies, survival of patients with metastatic spine disease (MSD) has also continued to improve. Thus, it is of an utmost priority for spine surgeons treating patients with MSD to understand the landscape of molecular subtypes and associated therapies. We sought to review the literature on this topic and develop a high-yield review for the treating spine surgeon.
Methods
A review of the literature was performed using PubMed, Google Scholar, and Medline databases. Histology-specific guidelines from the National Comprehensive Cancer Network (NCCN) were also reviewed. Articles that discussed the treatment of MSD patients with described molecular mutations with targeted therapies, as well as clinical outcomes, were included.
Results
The authors provide a framework for actionable mutations of malignancies commonly leading to MSD. Hormone receptor (HR) mutations as well as human epidermal growth factor receptor (HER2) mutations in primary breast cancer tumors confer a survival advantage as opposed to patients with triple negative breast cancer. Notably, a small number of patients with HR responsive breast cancer develop resistance to endocrine therapies in the setting of metastatic disease, and thus cannot receive targeted treatment following surgery. While prostate cancer is often initially hormone responsive, eventually tumors develop resistance, and few targeted therapies are limited. BRAF-targeted mutations for treatment of metastatic melanoma confer survival benefit when compared to chemotherapy alone. As with all systemic therapies, these medications all confer risk for patients undergoing surgical intervention, especially with regard to wound healing and bleeding.
Conclusion
While a vast range of targeted therapies exist, we present a review relevant to those treating patients with MSD. Many patients with MSD have a tumor histology with an actionable mutation, thus preserving neurologic function in these patients is of high priority but not without risk.