COSA 2014* Novel approaches to NSCLC 2015: COSA 2014 annual meeting (#46)
The last five years have witnessed dramatic progress in the treatment of advanced non-small cell lung cancer. This progress is fueled by accurate molecular profiling. The understanding that EGFR and ALK represent two distinct and important subcategories of non-small cell lung cancer is one of the most important findings that drives innovation. We know now that upfront tyrosine kinase inhibitor therapy for both groups of patients is the standard of care. In 2014 we learned that second and third generation EGFR inhibitors are able to provide prolonged benefit in patients who progress despite first-line drugs. In ALK similar findings have led to the FDA approval of a new agent for treating ALK positive patients. Remaining questions are how these new drugs will influence the first line approach to these diseases. For patients who do not carry EGFR or ALK, antibody therapy targeting immune checkpoint targets has become a remarkably effective way to treat advanced disease. Drugs against PD-1 or PDL-1 have been shown to have substantial response rates in patients with metastatic non-small cell lung cancer who have progressed despite prior chemotherapy. What remains unknown is how to best select patients who will benefit from these agents. There is some eraly work that suggests that staining for PDL-1 expression or TIL cell presence could select a patient population is most likely to benefit. This question remains unanswered and will be the focus of much research in the next five years. A second major open question with the use of the checkpoint inhibitors is the potential interaction with either tyrosine kinases inhibitors or chemotherapy in the front line setting. Additional large randomized international clinical trials will address these questions and will likely define a new paradigm for treating advanced non-small cell lung cancer.
