The role of germline mutations in thoracic malignancies: between myth and reality

Considering the established contribution of environmental factors to the development of thoracic malignancies, the inherited susceptibility of these tumors has rarely been explored. However, the recent introduction of next-generation sequencing (NGS)-based tumor molecular profiling in the real-word setting enabled us to deeply characterize the genetic background of lung cancer patients with or without smoking-related history, increasing the likelihood of detecting germline mutations with potential prevention as well as treatment implications. Pathogenic germline variants have been detected in 2-3% of non-small cell lung cancer patients undergoing NGS analysis, while the proportion of germline mutations associated with the development of pleural mesothelioma widely varies across different studies, ranging between 5 and 10%. This review provides an updated summary of emerging evidence about germline mutations in thoracic malignancies, focusing on pathogenetic mechanisms, clinical features, therapeutic implications as well as screening recommendations for high-risk individuals.