Onko News AUSTRIA

Chemotherapy for advanced or metastatic lung carcinoma has evolved slowly with limited progress between 1948 and the beginning of the 21st century. Until then, only minimal gains in long-term OS had been achieved, and the benefit of chemotherapy was discussed in a controversial manner. 

Lung cancer in young adults is relatively rare, but it is considered a unique subgroup with distinct biology. In patients aged ≤ 40 years, the incidence of lung cancer has been found to be 4 %, and in those aged ≤ 45 years, 5.3 %.

Lung cancer in young adults is relatively rare, but it is considered a unique subgroup with distinct biology. In patients aged ≤ 40 years, the incidence of lung cancer has been found to be 4 % [2], and in those aged ≤ 45 years, 5.3 %.

Early detection of lung cancer is a highly unmet medical need. Even though low-dose computed tomography (LDCT) has been shown to improve lung cancer mortality in high-risk individuals, the rate of clinical adoption remains low at 1.9 %. Cell-free DNA (cfDNA) testing might substitute LDCT as a screening tool, according to preliminary results of the Circulating Cell-free Genome Atlas (CCGA) Study presented at the ASCO Congress.

Extensive-disease small-cell lung cancer (ED-SCLC) is highly responsive to first-line therapy, but early relapses commonly occur, and prognosis is poor. To date, no biomarker-driven therapies have been established.
Based on the involvement of the immune system in the pathophysiology of SCLC and the high mutational burden of this disease, immunotherapy has potential as a novel treatment option.

Afatinib has been licensed for the second-line treatment of patients with squamous-cell carcinoma of the lung. A combination trial is ongoing that is testing afatinib plus pembrolizumab. What can we expect from this regimen?

EGFR TKI treatment has become a standard first-line strategy for patients with advanced, EGFR-mutation–positive NSCLC. Established agents include the first-generation drugs gefitinib and erlotinib, the second-generation agents afatinib and dacomitinib, and the third-generation TKI osimertinib. Combinations of EGFR TKIs with other drug classes might lead to outcome optimisation, for instance the additional administration of anti-angiogenic drugs, such as bevacizumab and ramucirumab.

Various clinical factors beyond PD-L1 expression have been explored as predictors of response to immune checkpoint inhibition. Specifically, analyses have associated lack of tobacco exposure with diminished responsiveness to PD-1 pathway blockade in NSCLC. One possible explanation for this is that lung cancers arising in never or minimal smokers generally show low TMB.

Monotherapy with the anti-PD-1 monoclonal antibody pembrolizumab has significantly improved clinical endpoints compared to chemotherapy in patients with metastatic non–small-cell lung cancer (NSCLC). KEYNOTE-024 showed overall survival (OS) improvement in addition to a progression-free survival (PFS) benefit; moreover, patients treated with pembrolizumab had a better safety profile than those receiving chemotherapy.

Standard treatment for patients with ALK-positive, advanced NSCLC includes the first-generation ALK inhibitor crizotinib and, more recently, second-generation ALK TKIs such as ceritinib and alectinib. The global, phase III ALEX trial tested the highly selective, CNS-active ALK inhibitor alectinib as first-line agent compared to crizotinib in patients with stage IIIB/IV ALK-positive NSCLC. 

Lung cancer (LC) is the leading cause of tumor deaths worldwide. Per year, 1.8 million people are diagnosed with LC, and the annual death toll amounts to 1.6 million. Non–small-cell lung cancer (NSCLC) is the most common type, which accounts for 85% of LC cases.

Over the last decade, the increasing understanding of critical molecular and cellular mechanisms which drive tumor initiation, maintenance, and progression in non-small-cell lung cancer (NSCLC) have contributed to the discovery of various novel drug targets and the development of new treatment strategies. 

Squamous cell carcinoma (SqCC) is one of the histopathological subtypes of non–small-cell lung cancer (NSCLC), and it accounts for 20 % to 30 % of these patients. Unfortunately, few studies have explored the treatment options for patients with SqCC, and progress in SqCC treatment lags behind other histopathological and/or molecular subtypes of NSCLC.

The emergence of EGFR TKIs has changed the standard of care in EGFR-mutant NSCLC patients. IPASS was the first open-label randomized study to compare the first-generation EGFR TKI gefitinib with platinum-based chemotherapy in Chinese patients with EGFR-mutant NSCLC.

Anaplastic lymphoma kinase (ALK) is a fusion oncogene, and the prevalence of ALK mutations in NSCLC patients is similar across different races. At CSCO 2017, the main progress for the treatment of ALK-mutant-positive NSCLC patients related to the new recommendations for first-line and second-line treatments, and the optimal strategies to manage patients before and after resistance to ALK tyrosine kinase inhibitors (TKIs).