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Review
. 2022 Jul 8:11:2022-2-4.
doi: 10.7573/dic.2022-2-4. eCollection 2022.

Advanced non-small-cell lung cancer: how to manage non-oncogene disease

Andrea De Giglio  1   2 , Alessandro Di Federico  1 , Chiara Deiana  1 , Biagio Ricciuti  3 , Marta Brambilla  4 , Giulio Metro  5
Affiliations
Review

Advanced non-small-cell lung cancer: how to manage non-oncogene disease

Andrea De Giglio et al. Drugs Context. .

Abstract

The therapeutic approach to patients affected by advanced non-small-cell lung cancer (NSCLC) is facing rapid and continuous evolution. In recent years, the emergence of new treatment strategies, such as immunotherapy and tyrosine kinase inhibitors, has revolutionized the treatment algorithm and the prognosis of patients with NSCLC. In the non-oncogene-addicted disease, immune-checkpoint inhibitors, either as single agents or combined with chemotherapy, outperformed standard chemotherapy in both untreated and previously treated patients. However, many patients still do not derive the expected benefit from current treatments. Despite representing the only biomarker currently used in clinical practice to guide treatment selection, PD-L1 expression has been proven an imperfect predictor of immunotherapy outcomes. The evaluation of clinical factors remains essential to detect patients that would benefit the most from a particular treatment approach, but the identification of additional biological and molecular predictive tools is a priority. Herein, we provide a comprehensive though concise review of the current treatment approaches to advanced NSCLC in patients without molecular driver alterations, with an additional focus on special populations, concomitant medications, and other considerations that might be useful for daily clinical practice.

Keywords: advanced non-small-cell lung cancer; chemotherapy; immunotherapy.

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Conflict of interest statement

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/06/dic.2022-2-4-COI.pdf

Figures

Figure 1
Figure 1
Overall survival and progression-free survival of pivotal upfront clinical trials in advanced, non-oncogene addicted, non-small-cell lung cancer. CBDCA, carboplatin; CM, Checkmate; EML, Empower Lung; IM, Impower; KN, Keynote; NSQ, non-squamous; SQ, squamous.
Figure 2
Figure 2
Overall survival and progression free survival of main clinical trials in advanced, non-oncogene-addicted, non-small-cell lung cancer progressing after first-line chemotherapy. ADC, adenocarcinoma; CM, Checkmate; IM, Impower; KN, Keynote; MO, months; NSQ, non-squamous; SQ, squamous.
Figure 3
Figure 3
Proposed approach to elderly patients (>70 years old). BSC, best supportive care; CT, chemotherapy; ECOG PS, Eastern Cooperative Group Performance Status; ICI, immune-checkpoint inhibitor.
Figure 4
Figure 4
Proposed approach to patients with ECOG PS 2, according to their PD-L1 status. BSC, best supportive care; CT, chemotherapy; ECOG PS, Eastern Cooperative Oncology Group Performance Status; ICI, immune-checkpoint inhibitor.
See this image and copyright information in PMC

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