Molecular Targets in Non-Small Cell Lung Cancer

Abstract

Background: Lung cancer is the second most common cancer in the United States among men and women, and it is the most common cause of cancer-related death. Non-small cell lung cancer (NSCLC) represents approximately 85% of all lung cancer cases. Historically, patients with metastatic NSCLC received similar cytotoxic chemotherapy regimens. Genotyping studies have revealed genetic/molecular abnormalities in lung cancer. These driver mutations render a cancer dependent on that specific mutation's biochemical pathway for its growth and survival. With the development of tyrosine kinase inhibitors and antibodies against specific driver mutations, the landscape of lung cancer treatment has changed from treatment based on histologic subtype to treatment based on molecularly defined subtypes.

Methods: In this article, we review the current molecular-targeted therapies in lung cancer.

Results: We review landmark trials that have led to approval of molecular-targeted therapies against epidermal growth factor receptor, anaplastic lymphoma kinase, and ROS1. We also explore less common mutations/molecular abnormalities and review data on the use of targeted therapies against them. Finally, we offer a treatment algorithm for patients with metastatic NSCLC that harbors actionable mutations.

Conclusion: Patients with advanced NSCLC should undergo mutational testing to evaluate for actionable mutations. If such a mutation is discovered, targeted therapy should be considered for first-line treatment.

Keywords: Anaplastic lymphoma kinase; ROS1; carcinoma–non-small cell lung; molecular targeted therapy; receptor–epidermal growth factor.

Figure.

Treatment algorithm for patients with advanced/metastatic non–small cell lung cancer. ALK, anaplastic lymphoma kinase; BRAF, B-Raf proto-oncogene; CNS, central nervous system; EGFR, epidermal growth factor receptor; PD-L1, programmed death-ligand 1; ROS1, ROS1 proto-oncogene; RET, RET proto-oncogene.