Lung Cancer

Plasma- and urine-based assays designed to detect actionable mutations in patients with non–small cell lung cancer are changing the face of treatment for these patients.

Molecular testing is done for patients with non–small cell lung cancer to determine what genetic abnormalities are present. If a common-enough mutation is detected—such as EGFR or ALK—then patients are able to receive a targeted agent matched to that driver.

Osimertinib, an EGFR tyrosine kinase inhibitor (TKI), is quickly emerging as a therapeutic option for patients with EGFR-mutant non-small cell lung cancer (NSCLC) who develop the acquired resistance mutation T790M.

Frontline therapy for patients with ALK-positive non–small cell lung cancer is poised to change in the coming years, as researchers continue to explore agents beyond crizotinib.

The Committee for Medicinal Products for Human Use has recommended approval of alectinib as a treatment for patients with metastatic ALK-positive non—small cell lung cancer following progression on crizotinib.

The Committee for Medicinal Products for Human Use (CHMP) has recommended approval of frontline pembrolizumab for the treatment of patients with metastatic non–small cell lung cancer whose tumors do not harbor EGFR or ALK mutations.

Luciano Mutti, MD, professor in Cancer Research, University of Salford Manchester, discusses predicting clinical response to immunotherapy agents for patients with mesothelioma.

Though testing for mutations in EGFR, ALK, and ROS1 is a standard approach in patients with non–small cell lung cancer, the same is not true for less common genetic abnormalities, including RET, BRAF, c-MET, and NTRK.

Researchers are exploring VEGF and EGFR inhibitors in combination with other therapies for patients with non–small cell lung cancer in hopes of maximizing clinical outcomes while keeping toxicity levels low.

Treatment with the PD-1 inhibitor nivolumab showed promising results in patients with recurrent malignant pleural mesothelioma.

The field of lung cancer has undoubtedly seen notable advances over the past year—especially with the game-changing November 2016 approval of pembrolizumab for the frontline treatment of patients with non–small cell lung cancer.

Beyond the strong efficacy outcomes observed with single-agent immunotherapies in non–small cell lung cancer—including pembrolizumab, nivolumab, and atezolizumab—the field is now awaiting the next phase: combination regimens.

Tepotinib, an investigational small molecule that targets a recently identified aberration in the MET gene, is moving forward rapidly in clinical development for patients with non–small cell lung cancer who harbor the mutation, raising hopes that a more specific attack on the signaling pathway will lead to a new therapy for a significant subgroup of individuals with the disease.

Determination of the PD-L1 status of a patient’s tumor has become increasingly important for informing the clinical decision whether to offer certain immunotherapeutic agents, making standardization of the tests and antibodies used to determine the PD-L1 status necessary to provide accurate and consistent results.