Hypoxia in Lung Cancer Management: A Translational Approach

Abstract

Lung cancer represents the first cause of death by cancer worldwide and remains a challenging public health issue. Hypoxia, as a relevant biomarker, has raised high expectations for clinical practice. Here, we review clinical and pathological features related to hypoxic lung tumours. Secondly, we expound on the main current techniques to evaluate hypoxic status in NSCLC focusing on positive emission tomography. We present existing alternative experimental approaches such as the examination of circulating markers and highlight the interest in non-invasive markers. Finally, we evaluate the relevance of investigating hypoxia in lung cancer management as a companion biomarker at various lung cancer stages. Hypoxia could support the identification of patients with higher risks of NSCLC. Moreover, the presence of hypoxia in treated tumours could help clinicians predict a worse prognosis for patients with resected NSCLC and may help identify patients who would benefit potentially from adjuvant therapies. Globally, the large quantity of translational data incites experimental and clinical studies to implement the characterisation of hypoxia in clinical NSCLC management.

Keywords: HIF; angiogenesis; hypoxia; lung cancer management; non-small cell lung cancer; oxygen sensing.

Figure 1

Schematic representation of lung cancer properties induced by hypoxic conditions. Hypoxia drives many mechanisms broadly involved in aggressiveness, invasion, and leading to the acquisition of metastatic properties. Additionally, oxygen deprivation supports the modulation of inflammation associated with an immune escape.

Figure 2

Molecular, cellular, and whole-organism techniques to assess hypoxic status in lung cancer. Various methods to define hypoxic features are currently available or in development to meet clinician’s expectation.