Current Landscape of Non-Small Cell Lung Cancer: Epidemiology, Histological Classification, Targeted Therapies, and Immunotherapy

Abstract

Non-small cell lung cancer (NSCLC) is a subtype of the most frequently diagnosed cancer in the world. Its epidemiology depends not only on tobacco exposition but also air quality. While the global trends in NSCLC incidence have started to decline, we can observe region-dependent differences related to the education and the economic level of the patients. Due to an increasing understanding of NSCLC biology, new diagnostic and therapeutic strategies have been developed, such as the reorganization of histopathological classification or tumor genotyping. Precision medicine is focused on the recognition of a genetic mutation in lung cancer cells called “driver mutation” to provide a variety of specific inhibitors of improperly functioning proteins. A rapidly growing group of approved drugs for targeted therapy in NSCLC currently allows the following mutated proteins to be treated: EGFR family (ERBB-1, ERBB-2), ALK, ROS1, MET, RET, NTRK, and RAF. Nevertheless, one of the most frequent NSCLC molecular sub-types remains without successful treatment: the K-Ras protein. In this review, we discuss the current NSCLC landscape treatment focusing on targeted therapy and immunotherapy, including first- and second-line monotherapies, immune checkpoint inhibitors with chemotherapy treatment, and approved predictive biomarkers.

New Trends in Precision Medicine: A Pilot Study of Pure Light Scattering Analysis as a Useful Tool for Non-Small Cell Lung Cancer (NSCLC) Diagnosis

“…In most patients, NSCLC is diagnosed after a long medical examination performed from the onset symptoms, such as persistent cough, a non-resolving lung infection, dyspnoea, presence of blood in the sputum, etc. [2]. Moreover, to be diagnosed, NSCLC needs diagnostic imaging and, in the end, a biopsy sample to determine the stage of tumour progression.…”

“…To accomplish this target, we performed label-free light scattering analysis of pleural washing and analysed our outcome with the help of machine learning, which enabled us to precisely characterize different cell types involved in an NSCLC event. Therefore, our results can significantly help in the diagnosis and therapeutic decisions of NSCLC events [2,4,[12][13][14]. However, our presented morphological single cell analysis is able to reveal small structural modification of cells and therefore can retrieve several biophysical cell properties, such as the cell dimension, the dimensional relationship between the nucleus and the cytoplasm and the optical density of cellular sub-compartments [15][16][17][18].…”

“…This procedure has several disadvantages both for the patientwho is the object of a real invasive surgery technique-and for the hospital, since this procedure is very expensive and time consuming. Such difficulties are particularly of interest when dealing with tumours with difficult surgical access and a high mortality rate, such as non-small cell lung cancer (NSCLC) [1,2], which is the main cause of death in men and the second one in women worldwide, with a 5-year overall survival rate of 20-25% for all stages [3]. This is due to the fact that, since occult micro metastases not even detectable with high-resolution imaging procedures can be present, patients in the early stages undergo surgery, but only 12% survive longer than 5 years.…”

“…Several other methods for the detection of CTC exist (ISET, Screen cell, etc. ), but they are expensive, time consuming, complex in implementation and generally provide complicated and not-immediate data that require highly specialized personnel to be correctly interpreted [2]. Schematic representation of the experimental approach.…”

Enhancing the Therapeutic Efficacy of KRASG12C Inhibitors in Lung Adenocarcinoma Cell Models by Cotargeting the MAPK Pathway or HSP90

“…Based on the histopathological presentation, lung cancer is categorized into two major groups: non-small cell lung carcinoma (NSCLC, ∼85%) and small cell lung carcinoma (SCLC, ∼15%). In NSCLC, adenocarcinoma (ADC) and squamous cell carcinoma (SCC) are the two major subtypes, accounting for ∼80% of the cases in total [ 2 ]. Despite traditional platinum-based chemotherapy and radiotherapy, the median survival time of NSCLC patients at advanced disease stages was previously dismal, but the situation has been significantly improved by the use of target drugs since the early 2000s and, more recently, by immunotherapy [ 2 – 4 ].…”