Treatment of Multifocal Lung Adenocarcinoma

Lung bronchoalveolar carcinoma (BAC) or adenocarcinoma in situ (AIS) continues to represent a
poorly understood clinical entity. A frequent clinical dilemma in lung cancer care is the
management of a documented or suspected invasive adenocarcinoma in the setting of multifocal
ground glass opacity (GGO) consistent with multifocal AIS. These patients are typically
classified as stage IV disease, and treated with palliative chemotherapy. No existing
pathologic or molecular test is currently capable of making the distinction between
independent primary versus metastatic tumors, a distinction for which substantial treatment
impact exists. Many treating physicians suspect that outcomes for this specific patient
subgroup are better than norms for stage IV disease, as such patients are frequently
node-negative and without distant metastases despite multiple lesions present. To address
this issue, we will evaluate a multimodality treatment protocol using aggressive local and
targeted systemic therapy for multifocal lung adenocarcinoma, incorporating information from
tumor genome sequencing for individualized treatment planning. The results will have
significant impact in advancing the biologic understanding and treatment approach for lung
adenocarcinoma in the setting of multifocal AIS.

- Patient must be > 18 years of age

- Two or more GGO's or solid lesions suspicious for multifocal disease.

- Clinical diagnosis of N0

- No evidence of distant metastases

- No prior intra-thoracic radiation therapy (NOTE: Previous radiotherapy as part of
treatment for head and neck, breast, or other non-thoracic cancer is permitted.),
previous chemotherapy, or surgical resection for non-small cell lung cancer (NSCLC).

- No other cancer in the past 5 years except early stage prostate cancer, or basal cell
of skin.

- PFT's that show patient is capable of tolerating a lung resection.

- Non-pregnant and non-lactating. Women of child-bearing potential must have a negative
urine or serum pregnancy test to participate in the study.

- Patient must be able to understand and willing to sign an IRB-approved informed
consent document.