“There is a growing list of approved targets and therapies included in the 2018 NCCN Guidelines for Non–Small Cell Lung Cancer [NSCLC] as well as emerging targets. Why does this matter? Because targeted therapies improve survival,” said Karen L. Reckamp, MD, MS, Co-Director, Lung Cancer and Thoracic Oncology Program, and Professor, City of Hope Comprehensive Cancer Center.
“With no targeted therapy, median survival for a select group of patients with NSCLC is 2 years. If there is an oncologic driver and no targeted therapy is given, median overall survival [OS] is approximately 2 years. But, when there is an oncologic driver and targeted therapy is given, median OS jumps to over 3 years,” she told the audience at the NCCN 23rd Annual Conference.1
The list of mutations with approved targeted therapies includes EGFR mutations (present in 30%–40% of Asians2 and 10%–20% of Caucasians),3 ALK rearrangements (present in up to 7%), ROS1 rearrangements (1.7%), and BRAF mutations (present in 2%). Other targets with therapies that are not approved for use in NSCLC include HER2 (present in 2%), RET (present in 1.7%), MET (present in 10%), and NTRK (present in <1%).
The 2018 NCCN Guidelines recommend molecular testing to make the initial diagnosis, and this is then followed by PD-L1 testing. For adenocarcinoma, testing is recommended for EGFR, ALK, ROS1, and BRAF mutations as part of broad molecular profiling, in addition to PD-L1 testing. For squamous cell carcinoma, the recommendation is to consider testing for the same 4 mutations in a subset of patients and to perform PD-L1 testing in all patients.
Dr. Reckamp has disclosed that she has received grant/research support from AbbVie; ACEA; Adaptimmune; ARIAD Pharmaceuticals, Inc.; Boehringer Ingelheim GmbH; Bristol-Myers Squibb Company; Genentech, Inc.; Guardant; Loxo Oncology; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Seattle Genetics; and Xcovery. She has also received consulting fees/honoraria from Amgen Inc., ARIAD Pharmaceuticals, Inc., Astellas, Euclises, and Tesaro, Inc.
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