Review Features Clinical Challenges of Personalized Treatment in NSCLC
Posted: Tuesday, September 4, 2018
Although recent developments in personalized targeted therapy approaches have improved the quality of life and survival among many patients with non–small cell lung cancer (NSCLC), secondary mutations lead to molecular resistance, and so clinical challenges remain. The authors of a recent review of this topic, published in the Journal of Clinical Investigation Insight, suggest that “between the crossroads of targeted therapy and immunotherapy lies the solution for better and longer lives for all cancer patients.”
“The recent success of immunotherapy in NSCLC offers hope that a person’s immune system can be harnessed to more comprehensively control cancer in even those with oncogenic drivers,” the authors, Suchita Pakkala, MD, and Suresh S. Ramalingam, MD, both of Emory University School of Medicine, Winship Cancer Institute, Atlanta, concluded.
NSCLC provides an opportunity for the extensive use of personalized treatment. Now part of routine clinical care, targeted therapies among patients with activating mutations in EGFR, BRAF, and rearrangements in ALK and ROS1 extended the median survival from several months to more than 3 years for those with stage 4 disease. However, escape mechanisms enable therapy resistance and can outpace drug effects. Research continues to evolve to inhibit on-target alterations, bypass pathways, and histologic transformations as well as to combat secondary resistance.
Despite the rapid evolution and increased success of targeted therapies, approximately one-third of EGFR and ALK tyrosine kinase inhibitor resistance remains unknown. The authors stressed the need for more research regarding techniques to address and prevent the mechanisms of resistance.