Targeted and more-individualized treatment for NSCLC becomes a reality.
Lung cancers used to be diagnosed solely by a visual microscopic examination of tumor tissue and all patients received the same chemotherapy. Now, doctors are personalizing care by finding the genetic alterations within the cancer that drive its growth and then use medicines that specifically counteract the cancerous effects of those genes. In addition, these “targeted therapies” are designed to treat only the cancer cells and minimize damage to normal, healthy cells. The ability to test a patients’ cancer for individual differences at the genetic level and to make treatment decisions based on those differences is the hallmark of precision medicine.
Tailored treatments have emerged to match a person’s genetic makeup or a tumor’s genetic profile. As a result, ALL patients with lung cancer should receive molecular testing for epidermal growth factor receptor (EGFR), the anaplastic lymphoma kinase (ALK) mutation, and the ROS-1 mutation—the results of which can guide their physicians in determining which therapies are more likely to be effective. In fact, guidelines now recommend that molecular testing on a sample of the cancer taken during a biopsy should be considered before deciding upon treatment.1 Results from these tests provide important information about every patient’s cancer so that treatment decisions can be tailored accordingly.
Treatment strategies are individualized based upon the test results to include agents that specifically target each patient’s cancer characteristics to achieve optimal outcomes.
PD-1: PD-1 is a protein that inhibits certain types of immune responses, allowing cancer cells to evade an attack by certain immune cells. Drugs that block the PD-1 pathway enhance the ability of the immune system to fight cancer and are referred to as checkpoint inhibitors for their ability to help the immune system recognize and attack cancer. Overall 66% of lung cancer patients have some expression of PD-1, and 28% are “high expressers” with over 50% of the tested tumor expressing PD-1.1
EGFR: The epidermal growth factor receptor (EGFR) pathway is a normal biologic pathway found in healthy cells. It is involved in regular cellular division and growth. However, certain mutations within the EGFR gene can lead to an overactive EGFR pathway, leading to the development and/or spread of cancer. These cancers are referred to as EGFR-positive, and there are several FDA-approved medications to block the activity of EGFR and slow cancer growth for EGFR-positive cancers. EGFR mutations are most common in people of Asian ethnicity, women, never-smokers, and those with a type of lung cancer known as adenocarcinoma.
FDA-approved medications that block EGFR activity in NSCLC include the following: Each is indicated for different treatment phases of NSCLC, and works via slightly different mechanisms so when one stops working, another may still be useful.1
- Tarceva® (erlotinib)
- Gilotrif® (afatinib)
- Iressa® (gefinitib)
- Tagrisso® (osimertinib)
- Necitumumab® (Portrazza)
ALK+ Lung Cancer: Approximately 5% of all NSCLC have an identified mutation referred to as the anaplastic lymphoma kinase (ALK) mutation. The ALK mutation is responsible for initiating and promoting cancer growth. Individuals with ALK+ lung cancer tend to be non-smokers or former light smokers; younger, and are a type of NSCLC referred to as adenocarcinoma (based upon the cells affected); and respond worse to standard chemotherapy regimens than patients who do not have the ALK mutation.
Recently, agents have been developed to specifically reduce or decrease cellular growth and spread caused by the ALK mutation.
FDA Approved Agents for ALK+- Lung Cancer
- Xalkori® (crizotinib)
- Alcensa® (alectuzumab)
- Zykadia® (ceritinib)
ROS-1+ Lung Cancer: The ROS-1 mutation is an uncommon mutation found in only 1% of individuals with NSCLC. Research has indicated that the ROS-1 mutation plays a role in the development and progression of some lung cancers, and patient characteristics are similar to those who have ALK+ NSCLC.
FDA Approved Agent for ROS-1 Lung Cancer
- Xalkori® (crizotinib)
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