Radiation-induced KRAS G12V mutant lung adenocarcinoma in a never smoker

The molecular profile of radiation-induced cancers remains poorly understood. This case report describes a 59-year-old male never smoker with a distant history of Hodgkin's lymphoma treated with mantle radiation who decades later develops primary lung adenocarcinoma within the prior radiation portal. Genomic profiling of the cancer demonstrated a KRAS G12V mutation. We briefly review the clinical entity of radiation-induced second malignancies and KRAS mutant lung adenocarcinoma. Although to date there is no standard molecularly targeted therapy available for KRAS mutant lung cancer, prior reports of activating EGFR mutations in a proportion of radiation-induced lung cancers suggest that a variety of genomic alterations may occur in these secondary malignancies. Given the potential to identify other molecularly defined subsets of lung cancer for which specific therapies exist, routine molecular profiling of these cases seems reasonable.