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      Update 2020: Management of Non-Small Cell Lung Cancer

      review-article
      Author(s): 1 , 2 , 2 ,
      Publication date (Electronic):
      Journal: Lung
      Publisher: Springer US
      Keywords: Lung cancer, Immune checkpoint inhibitors, Targeted therapy

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          Abstract

          The past decade has seen a revolution of new advances in the management of non-small cell lung cancer (NSCLC) with remarkable progresses in screening, diagnosis, and treatment. The advances in systemic treatment have been driven primarily by the development of molecularly targeted therapeutics, immune checkpoint inhibitors, and anti-angiogenic agents, all of which have transformed this field with significantly improved patient outcomes. This review will address updates in lung cancer screening, liquid biopsy, and immunotherapy in the front-line setting. We discuss recent advances and highlight the plethora of new approvals of molecular-targeted therapy for subgroups of NSCLC patients with sensitizing EGFR, ALK, ROS1, RET, BRAF V600E, MET, and NTRK alterations.

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          Most cited references42

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          Cancer statistics, 2020

          Rebecca Siegel, Kimberly D Miller, Ahmedin Jemal (2020)
          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.
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            Pembrolizumab versus Chemotherapy for PD-L1–Positive Non–Small-Cell Lung Cancer

            Martin Reck, Delvys Rodriguez-Abreu, Andrew G Robinson … (2016)
            Pembrolizumab is a humanized monoclonal antibody against programmed death 1 (PD-1) that has antitumor activity in advanced non-small-cell lung cancer (NSCLC), with increased activity in tumors that express programmed death ligand 1 (PD-L1).
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              Pembrolizumab plus Chemotherapy in Metastatic Non–Small-Cell Lung Cancer

              Rina Hui, Takayasu Kurata, Silvia Novello … (2018)
              First-line therapy for advanced non-small-cell lung cancer (NSCLC) that lacks targetable mutations is platinum-based chemotherapy. Among patients with a tumor proportion score for programmed death ligand 1 (PD-L1) of 50% or greater, pembrolizumab has replaced cytotoxic chemotherapy as the first-line treatment of choice. The addition of pembrolizumab to chemotherapy resulted in significantly higher rates of response and longer progression-free survival than chemotherapy alone in a phase 2 trial.
              Article 0 comments Cited 2079 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Haiying Cheng:
                ORCID: http://orcid.org/0000-0002-6051-2732
                hcheng@montefiore.org
                Journal
                Journal ID (nlm-ta): Lung
                Journal ID (iso-abbrev): Lung
                Title: Lung
                Publisher: Springer US (New York )
                ISSN (Print): 0341-2040
                ISSN (Electronic): 1432-1750
                Publication date (Electronic): 11 November 2020
                Pages: 1-11
                Affiliations
                [1 ]GRID grid.259828.c, ISNI 0000 0001 2189 3475, Hollings Cancer Center, , Medical University of South Carolina, ; Charleston, SC USA
                [2 ]GRID grid.240283.f, ISNI 0000 0001 2152 0791, Department of Oncology, , Montefiore Medical Center, Albert Einstein College of Medicine, ; Bronx, NY 10461 USA
                Author information
                http://orcid.org/0000-0002-6051-2732
                Article
                Publisher ID: 407
                DOI: 10.1007/s00408-020-00407-5
                PMC ID: 7656891
                PubMed ID: 33175991
                SO-VID: 8cfdb061-44ba-415f-8e6c-a150b2f01501
                Copyright © © Springer Science+Business Media, LLC, part of Springer Nature 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 26 July 2020
                Date accepted : 2 November 2020
                Categories
                Subject: State of the Art Review

                ScienceOpen disciplines: Respiratory medicine
                Keywords: lung cancer,immune checkpoint inhibitors,targeted therapy
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: lung cancer, immune checkpoint inhibitors, targeted therapy

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