Personalized medicine for lung cancer patients is on the horizon as a result of recommendations issued by the International Association for the Study of Lung Cancer (IASLC). As described in a news release from IASLC, therapies can increase survival by years if patients are assigned to treatments showed to be effective in other patients with similar tumor molecular characteristics.
Specifically, if patients have advanced non-small cell lung cancer (NSCLC) with an adenocarcinoma histology component, the ideal treatment may be epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). “EGFR mutations were discovered ten years ago and first-line EGFR TKIs were established six years ago, and now we have a plan to prolong the efficacy of molecularly-targeted therapeutics at the time of resistance,” said Tony Mok, MD, President of IASLC. “With that I am optimistic that we will prolong the survival for many lung cancer patients.”
Efficacy of TKI treatment is contingent on the results of testing for mutations in the EGFR gene. For patients with a mutation who are treated with TKIs, prognosis improves significantly. “A new era in personalized medicine for patients with advanced lung cancer arose with the discovery that mutations in the EGFR gene cause constitutive activation of the receptor, which “drives” the cancer, and that drugs such as erlotinib, gefitinib, and afatinib that bind to the receptor produce high response rates and long remission in patients with these mutations,” noted Paul A. Bunn, Jr, MD, former Director of IASLC.
Erlotinib, gefitinib, and afatinib are not the only EGFR inhibitors. A new generation of TKIs has shown efficacy in patients: AZD9291 and rociletinib have been approved by the Food and Drug Administration. These two drugs are of particular utility in cases of patients who have developed resistance to first generation TKIs. Additionally, Dr. Bunn stated, “Not only do these oral agents have considerably less toxicity that chemotherapy but they produce prolonged survival that can be increased even further by the third generation drugs when introduced at the time of progression. Thus, patients may live considerably longer on the oral-targeted drugs compared to chemotherapy without the severe toxicity.”
In addition to EGFR gene mutations, anaplastic lymphoma kinase (ALK) gene mutations should be tested. Individuals with positive ALK levels can be treated with ALK TKIs to increase positive prognosis over that of other therapies.
Essentially, patients with known genetic backgrounds may have higher chances of successful lung cancer treatment. A large body of published research has created a list of suggestions for patients with certain molecular signatures of lung cancer, and the efforts can be applied in the clinic.