Current procedures and news in the treatment of lung cancer

02/2021

Doc. MUDr. Milada Zemanová, Ph.D.

Onkologická klinika 1. LF UK a VFN, Praha

SUMMARY

Lung cancer in the Czech Republic is the cause of almost 5 and a half thousand deaths per year, the median survival of metastatic and recurrent tumors with standard chemotherapy is approximately one year. For several years, the exception has been about 10% of patients with targeted treatment according to epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) translocation. Progress has been made with third-generation tyrosine kinase inhibitors (TKI) such as the anti-EGFR TKI osimertinib or the anti-ALK TKI alectinib, brigatinib and lorlatinib, which have made it possible to prolong median survival to 3 to 5 years. To administer effective molecularly targeted treatment in other rare molecular aberrations, such as ROS1, BRAF, KRAS, NTRK, cMET, HER2/neu, would allow the identification of this mutation using the next generation sequencing method and the subsequent reimbursement of the registered product. For most patients without driver mutations, the chance of greater treatment success is the possibility of including anti-tumor immunotherapy in the treatment algorithm as soon as possible after diagnosis. The reimbursed standard is durvalumab as consolidation therapy after concomitant chemoradiotherapy of inoperable non-small cell lung cancer (NSCLC) with programmed death-ligand 1 (PD-L1) ≥ 1%, with a median prolongation of survival to almost four years. In the first line of NSCLC treatment we have pembrolizumab monotherapy for PD-L1 ≥ 50% tumours and in combination with chemotherapy for PD-L1 ≥ 1%, in the second line nivolumab or atezolizumab is indicated regardless of PD-L1 expression. Other combinations for the first-line treatment of NSCLC with atezolizumab, nivolumab and pembrolizumab are registered. Overall, the use of anti-tumor immunotherapy in NSCLC reduces the risk of death by approximately 20-40%, with a median prolongation of survival between 16-30 months. Immunochemotherapy with durvalumab or atezolizumab is also significantly effective in extensive disease small cell lung cancer.

Key words

lung cancer, molecularly targeted therapy, next generation sequencing, immuno-oncology