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Treatment of oncogene-driven non-small cell lung cancer

Kastelijn, Elisabeth A.a; de Langen, Adrianus J.b; Peters, Bas J.M.c

Current Opinion in Pulmonary Medicine: May 2019 - Volume 25 - Issue 3 - p 300–307
doi: 10.1097/MCP.0000000000000572
GENETICS: Edited by Coline H.M. van Moorsel
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Purpose of review With the development of targeted therapies, the treatment strategy of patients with advanced or metastatic non-small cell lung cancer (NSCLC) has changed tremendously. In this review, we focus on the different aspects of the treatment of oncogene-driven NSCLC.

Recent findings Patients with an EGFR or ALK alteration show a better clinical outcome with tyrosine kinase inhibitor (TKI) treatment compared to chemotherapy.

Patients with a ROS1 rearrangement or a BRAF V600E mutation show favorable clinical outcome with TKI treatment compared to chemotherapy, although randomized trials are not available.

Patients on TKIs will eventually develop disease progression because of acquired resistance.

The treatment with immunotherapy in EGFR and ALK-positive NSCLC patients did not improve overall survival over that of chemotherapy.

Blood-based genetic analysis provides the opportunity to noninvasively screen patients for the presence of oncogenic drivers and to monitor resistance during TKI treatment.

Summary Targeted molecular therapies are now standard of care for patients with oncogene-driven NSCLC with a good clinical benefit and minimal toxicity. The role of immunotherapy in patients with molecular alterations is still unclear. Blood-based genotyping has gained interest in the diagnostic and resistance monitoring setting for patients with NSCLC.

aDepartment of Pulmonology, St. Antonius Hospital Utrecht/Nieuwegein, Utrecht

bDepartment of Thoracic Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam

cDepartment of Pharmacy, Sint Antonius Hospital Utrecht/Nieuwegein, Utrecht, The Netherlands

Correspondence to Elisabeth A. Kastelijn, MD, Soestwetering 1, 3543 AZ Utrecht, The Netherlands. E-mail: l.kastelijn1@antoniusziekenhuis.nl

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