Exon 20-Mutated NSCLC: Extending the Data Set to Allow the Recognition of Potential Causes

To the Editor:
The consortium responsible for collecting data from 175 patients with EGFR exon 20-mutant NSCLC, the European EXOTIC Registry, has added an important piece of information and for that we like to congratulate the authors. To make this resource even more valuable, we like to encourage the consortium to expand this important work beyond the identification of novel and better treatment approaches and to develop a plan to recognize causal factors associated with exon 20 mutations (molecular archaeology). EGFR mutations, including those affecting exon 20, are more frequent in nonsmokers and never-smokers. The increasing incidence of lung cancers in nonsmokers and never-smokers has been noticed in several parts of the world, and it is a formidable challenge to identify its cause(s) and to try to translate them into public health measures.

Asbestos and air pollution (particulate matter [PM]2.5) are important causes of lung cancer in nonsmokers and never-smokers, and genetic susceptibility may contribute...