Therapeutic landscape of metastatic non-small-cell lung cancer in Canada in 2020

Abstract

Lung cancer is the most commonly diagnosed cancer in Canada and remains associated with high mortality. Nevertheless, recent advances in the fields of immuno-oncology and precision medicine have led to significant improvements in clinical outcome in metastatic non-small-cell lung cancer (nsclc). Those improvements were facilitated by a greater understanding of the biologic classification of nsclc, which catalyzed discoveries of novel therapies. Here, we present a comprehensive review of the recent avalanche of practice-changing trials in metastatic nsclc, and we offer an approach to the management of this disease from a Canadian perspective. We begin with an overview of the pathologic and molecular characterization of metastatic nsclc. Next, we review the indications for currently approved immune checkpoint inhibitors, and we provide an approach to the management of disease with a driver mutation. Finally, we address future avenues in both diagnostics and therapeutics for patients with advanced and metastatic nsclc.

Keywords: Lung cancer; biomarkers; chemotherapy; immunotherapy; targeted therapy.

FIGURE 1

Immune checkpoint inhibition in the management of metastatic non-small-cell lung cancer without a driver mutation in January 2020. Pembro = pembrolizumab; Carbo = carboplatin; Cis = cisplatin; Gem = gemcitabine; Pem = pemetrexed; Nivo = nivolumab; Atezo = atezolizumab; ICI = immune checkpoint inhibition; Pacli = paclitaxel; Ipi = ipilimumab; Beva = bevacizumab.

FIGURE 2

Summary of selected targeted agents for the management of metastatic non-small-cell lung cancer with a driver mutation in January 2020. AEs = adverse events; ALT = alanine transaminase; AST = aspartate transaminase; CK = creatine kinase; ICI = immune checkpoint inhibition.