Targeted therapy moves to earlier stages of non-small-cell lung cancer: emerging evidence, controversies and future challenges

• Published in: Future oncology (London, England) Vol. 17; no. 30; pp. 4011 - 4025
• Main Authors: Mielgo-Rubio, Xabier, Martín, Margarita, Remon, Jordi, Higuera, Oliver, Calvo, Virginia, Jarabo, José Ramón, Conde, Esther, Luna, Javier, Provencio, Mariano, De Castro, Javier, López-Ríos, Fernando, Hernando-Trancho, Florentino, Couñago, Felipe
• Format: Journal Article
• Language: English
• Published: England Future Medicine Ltd 01-10-2021
• Subjects: adjuvant; afatinib; alectinib; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Combined Modality Therapy; crizotinib; early-stage; ErbB Receptors - antagonists & inhibitors; ErbB Receptors - genetics; erlotinib; gefitinib; Humans; localized NSCLC; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Molecular Targeted Therapy; Mutation; neoadjuvant; Neoplasm Staging; non-small-cell lung cancer; NSCLC; oncogenic driver; osimertinib; targeted therapy; ALK; oncogenic driver; targeted therapy; neoadjuvant; NSCLC; erlotinib; gefitinib; EGFR; alectinib; localized NSCLC; afatinib; crizotinib; adjuvant; osimertinib; early-stage; ROS1; non-small-cell lung cancer
• ISSN: 1479-6694; 1744-8301
• DOI: 10.2217/fon-2020-1255

Lung cancer continues to be the leading cause of cancer mortality and a serious health problem despite the numerous advances made in the last decade and the rapid advance of research in this field. In recent years, there has been a decrease in mortality from lung cancer coinciding with the approval times of targeted therapy. To date, targeted therapy has been used in the context of advanced disease in clinical practice, with great benefits in survival and quality of life. The next step will be to incorporate targeted therapy into the treatment of earlier stages of non-small-cell lung cancer, and there is already a randomized trial showing a disease-free survival benefit. However, there are many questions that need to be resolved first. In the present review, the authors discuss the findings of published reports and ongoing clinical trials assessing the role of targeted therapies in nonmetastatic disease.
The time has come to offer targeted therapy to patients with earlier-stage non-small-cell lung cancer, which could represent an important qualitative leap in the treatment of lung cancer patients. Review of evidence and discussion.
Despite major therapeutic advances over the last decade, lung cancer continues to present the highest mortality rate of all cancers. Precision and personalized therapy directed at specific alterations in the genetic material of the tumor as well as immunotherapy has significantly improved survival in metastatic non-small-cell lung cancer. The next step will be to incorporate precision medicine into the treatment of earlier stages of non-small-cell lung cancer. The recent publication of the results of the ADAURA phase III trial showing a significant improvement in disease-free survival in patients with resected EGFR-mutated non-small-cell lung cancer who received an adjuvant EGFR-directed tyrosine kinase inhibitor called osimertinib has opened the doors to the incorporation of this novel agent into routine clinical practice. However, there are many questions that need to be resolved first. In the present review, the authors discuss the findings of published reports and ongoing clinical trials assessing the role of precision medicine in nonmetastatic disease.