Review Offers 2018 Roadmap for Treating Advanced Non–Small Cell Lung Cancer
Posted: Wednesday, May 16, 2018
Over the past 20 years, therapeutic advances in non–small cell lung cancer (NSCLC) have been plentiful. With them have come the need for guidance on initial assessment of a new patient with NSCLC, particularly in the testing of lung tumors for driver mutations and rearrangements, which impact the choice of treatment. A review of the current treatment landscape in NSCLC, by Deborah B. Doroshow, MD, PhD, and Roy S. Herbst, MD, PhD, was published in JAMA Oncology.
For patients with nonsquamous cell disease who have EGFR-mutant disease, erlotinib/gefitinib/afatinib or the newer agent osimertinib is indicated. The recent phase III FLAURA trial showed that osimertinib improved median progression-free survival compared with erlotinib or gefitinib as a first-line therapy for patients with the most common EGFR mutations, although overall survival data are not yet mature. As for those with ALK rearrangement, crizotinib is indicated as a first-line option. However, the investigators noted, alectinib has been recently shown to improve progression-free survival over crizotinib in patients with this translocation (J-ALEX trial).
KRAS-mutant nonsquamous lung cancer, although a common mutation, is not yet targetable. However, ROS1, MET, RET, and ERBB2/HER2 are targetable mutations, with effective treatments available, so the investigators consider it important to screen for them.
Finally, Drs. Doroshow and Herbst emphasized that all patients with advanced lung cancer should have their tissue assessed for PD-L1 expression at baseline. Several studies have determined that higher tumor or immune cell expression of PD-L1 identified by immunohistochemical analysis is associated with improved responses to immune checkpoint inhibitors.
