Present standards and future perspectives in the treatment of metastatic non-small cell lung cancer

Abstract

The development of novel effective immunotherapeutic agents and early clinical data hinting at significant activity in non-small cell lung cancer (NSCLC) has introduced yet another player in the field of management of advanced disease. At present, first-line cytotoxic chemotherapy is generally withheld pending results of molecular testing for any actionable genetic alteration that could lead to targeted treatment, and in their absence chemotherapy is prescribed as a default therapy. Phase III trials comparing head-to-head immune checkpoint inhibitors with standard platinum-based doublet chemotherapy are underway. Second-line chemotherapy is likewise being challenged in phase III trials, one of which having recently reported positive results in advanced squamous cell carcinoma. In tumors harboring actionable transforming genetic alterations such as EGFR mutations and ALK rearrangements, second- and third-generation inhibitors allow for multiple lines of targeted treatment beyond initial resistance, postponing the use of cytotoxic chemotherapy to very late lines of therapy. Chemotherapy as a longstanding but still present standard of care capable of prolonging survival, improving quality of life, and relieving symptoms sees its role increasingly restricted to clinical, immunological, and molecular subsets of patients where its activity and efficacy have never been tested prospectively.

The association of PD-L1 expression with the efficacy of anti-PD-1/PD-L1 immunotherapy and survival of non-small cell lung cancer patients: a meta-analysis of randomized controlled trials

“…On the other hand, most patients do not have an actionable driver and may not benefit from targeted treatment (5). In this challenging clinical setting, immunotherapy is gradually changing the treatment pattern of NSCLC with improved response rates and impressive efficacy (6).…”

Microwave ablation versus radiofrequency ablation for the treatment of pulmonary tumors

“…Besides, the lung ranks second in the most common metastatic locations of extra - thoracic tumors [ 2 ]. For patients with early stage Non-Small Cell Lung Cancer (NSCLC), surgical resection remains the first-line therapy [ 3 ]. Lung metastasis is an indicator of advanced disease, for patients with in the lung and favorable general condition, resection can improve the prognosis [ 4 , 5 ].…”

CA916798 gene expression is associated with multidrug resistance and predicts progression‑free survival in patients with lung cancer

“…The 5-year overall survival rate for lung cancer is <20%, which is largely due to late diagnosis (3). Patients with lung cancer are often diagnosed at advanced stages, when treatment options are limited (4). Platinum-based chemotherapy is recommended for patients with metastatic disease, and the administration of concurrent chemotherapy and radiation is beneficial for advanced lung cancer (5).…”