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The acquisition of driver mutations in non-tumoral cells appears to be very important during the carcinogenesis of adenocarcinoma (ADC). Recent studies suggest that cancer-related mutations may not necessarily be present only in malignant cells, but also in histologically “healthy cells”.    Objective:  to demonstrate the presence of  EGFR  or  KRAS  mutations in non-tumoral lung cells in subjects with ADC and negative mutational status.    Results:  mutations in  EGFR  or  KRAS  oncogenes were identified in the normal lung in 9.7% of the subjects. Exon 21 substitution L858R in  EGFR  was detected in two cases while the exon 19 deletion E746-A750 in the  EGFR , the G12C and G12D substitutions in the  KRAS  were detected once. One patient presented three different mutations in the normal lung parenchyma ( EGFR _L858R,  KRAS _G12C and  KRAS _G12D). The negative-mutation status of the tumor and the mutations detected in the “normal lung” were confirmed using highly sensitive and specific TaqMan PCR (CAST-PCR). No differences were found in terms of progression, progression-free survival or overall survival during the 18 months follow-up.    Conclusions:  These results confirm the presence of driver mutations in the histologically normal lung parenchyma cells in the absence of mutations coexisting with the primary tumor.

EGFR and KRAS Mutations in Lung Parenchyma of Subjects With EGFR/KRAS Wild-Type Lung Adenocarcinoma