Lung Cancer Treatment in North America: Recent Advances and Future Promises
At the closing plenary session of the International Association for the Study of Lung Cancer (IASLC) 18th Annual World Conference on Lung Cancer (WCLC) in Yokohama, Japan, Paul A. Bunn, Jr, MD, presented a 2017 treatment algorithm for lung cancer and discussed where lung cancer research in North America is heading.1
According to Dr Bunn, PD-L1 testing and next-generation sequencing for molecular targets are now recommended for nearly all patients diagnosed with advanced lung cancer. Patients diagnosed with stage IV disease in particular are recommended for PD-L1 testing, and those with a PD-L1 tumor proportion score of more than 49% may receive pembrolizumab, a PD-1 checkpoint inhibitor, as a first-line monotherapy. Patients with a tumor proportion score of 1% through 49% may receive pembrolizumab with concurrent chemotherapy.
Patients with lung adenocarcinoma who have never smoked should be tested for mutations in EGFR, ALK, ROS1, and BRAF, to determine whether EGFR tyrosine kinase inhibitors (TKIs) or BRAF inhibitors are appropriate.
Depending on performance status, patients with stage IV disease without notable PD-L1 tumor expression or targetable tumor drivers are recommended for platinum doublet therapy with or without bevacizumab for angiogenesis inhibition.
For patients with less advanced disease, such as stage I to III resectable tumors, lobectomy, chemotherapy, and radiotherapy combinations are still the recommended standard, depending on the extent of disease and a patient’s performance status.
Dr Bunn added that “[i]t is likely that immunotherapy combinations and molecular combinations will be used in unresectable stage III disease before, after, or during [chemotherapy/radiotherapy] and will improve cure rates.”
He concluded that in addition to recent advances in treatment for lung cancer, immunotherapies and targeted therapies will likely be used for neoadjuvant care in early-stage disease. Prevention strategies will also be improved for individuals at high risk for lung cancer.
Read more of Cancer Therapy Advisor‘s coverage of the IASLC 18th World Conference on Lung Cancer (WCLC) by visiting the conference page.