Progress in the battle against lung cancer has been astoundingly rapid. Consider that, during the typical lung cancer treatment journey, a patient can receive a medication that didn’t exist when he or she was first diagnosed.1
Targeted therapy, a treatment modality that attacks the specific biologic cause of a cancer’s growth, has been an integral player in the lung cancer advancement story, in particular for non-small cell lung cancer (NSCLC). Used alone or with other treatments, targeted therapy is helping patients with aggressive late-stage NSCLCs live longer.2
Regional Cancer Care Associates (RCCA) is one of the nation’s leading cancer treatment networks with locations near you in New Jersey, Connecticut, Maryland, Massachusetts, and the Washington, D.C. area. Here, our expert oncologists and hematologists discuss the burgeoning role of targeted therapies in NSCLC and how the patients who might benefit most from this treatment are identified.
Non-small cell lung cancers, or NSCLCs, are cancers of the cells lining the surface of the lung airways. Despite numerous treatment and diagnostic advances, lung cancer overall is still the leading cause of cancer-related death in the United States,1 and the American Cancer Society projects that 2025 will see roughly 226,650 lung cancer diagnoses and about 124,730 deaths from the disease.3 Roughly 1 in 5 persons with any type of lung cancer is still alive 5 years after diagnosis.4
NSCLC is by far the most common lung cancer type, accounting for 85% of these cancers.5 NSCLC is less aggressive than other lung cancer types, but lung cancers can develop and linger in the lungs for years before coughing, shortness of breath, or other symptoms become noticeable.6 So, in 4 in 10 cases, an NSCLC will have spread beyond the lungs by the time it’s diagnosed.5
Smoking, which causes as many as 90% of lung cancer deaths in the United States,7 is the most prevalent risk factor for NSCLC. The more extensive a person’s smoking history, the greater the risk of developing NSCLC.5 Exposure to secondhand smoke, or radon, workplace exposure to asbestos or chemicals, and air pollution are less common but still possible causes.8
Lung cancer typically begins when cells have specific genetic changes (called “mutations”) that alter their normal makeup and cause them to proliferate and form tumors. Targeted therapies act against cancerous cells or the biological processes that support their development and growth, and this stops the cancer from growing and spreading.9
Targeted therapies have been shown to prolong survival among patients with late-stage NSCLCs that have spread, with as many as 1 in 2 patients surviving 5 years after diagnosis depending on the genetic mutation.2 The American Society of Clinical Oncology (ASCO) recommends use of different targeted therapies based on the mutation that is being targeted.2
Several types of targeted therapies are approved for specific NSCLCs, and each type works differently. These include:
Another type of targeted therapy, proteasome inhibitors, has been studied for NSCLC treatment,10 but none of these agents have yet been approved by the US Food and Drug Administration (FDA) for this use.
Targeted therapy differs from standard chemotherapy, a systemic treatment that travels throughout the bloodstream and can kill cancer cells anywhere in the body.9,11 In the process, chemotherapy can also attack healthy cells near the cancerous cells, and this can lead to bothersome side effects, most commonly hair loss and digestive discomfort.9,11
By contrast, targeted therapy has less of an effect on nearby healthy tissue, which reduces – but does not eliminate – the side-effect risk.1 Targeted therapies do cause side effects, with skin rash or dryness, changes in the nails, irritation or inflammation, fatigue, mild diarrhea, and nausea and vomiting among the most common.1,12
But as researchers continue to probe cancer-causing cellular changes and how to combat them, they’re also developing targeted therapies that more precisely target cancerous cells and cause fewer side effects. For example, the epidermal growth factor receptor (EGFR)–targeting TKI osimertinib, which was approved by the FDA in 2015,13 causes fewer side effects than the original EGFR inhibitors developed 20 years ago.1
Targeted therapies typically are used to treat aggressive late-stage NSCLCs.1,14 This therapy can be given alone or in combination with chemotherapy, immunotherapy, or another targeted agent depending on the mutation, the cancer’s aggressiveness, or the patient’s ability to tolerate multiple treatments.14
Not all patients with NSCLC are candidates for targeted therapy; only patients with NSCLC caused by a specific mutation are likely to respond to a targeted therapy formulated to address that genetic change. However, roughly 40% to 50% of patients with NSCLC have biomarkers that indicate their particular lung cancer would respond to a targeted therapy.1 These biomarkers signal alterations in the following 10 genes:1
EGFR and KRAS are the 2 most common types of mutations in NSCLC, accounting for about 40% of all alterations seen in this disease.1 Some mutations are most prevalent among people in an ethnic or demographic group or based on patient characteristics.1 For example, EGFR-driven lung cancers are most prevalent among women, Asians, and never-smokers, whereas KRAS and BRAF are most prevalent among current or former smokers.1
If you’re battling NSCLC, your oncologist might recommend biomarker testing to determine whether you have a genetic mutation that could be targeted.
Biomarker testing in NSCLC typically is done by removing a tissue sample from a tumor biopsy and analyzing it for mutations.15 Alternatively, a blood draw may be done if tissue samples are limited or cannot be obtained.15
Different types of biomarker tests are available.15 One type of test, next-generation sequencing, often is recommended in NSCLC because it can detect many biomarkers at one time.15
Biomarker testing also can detect presence of programmed death ligand 1 (PD-L1), a protein that cloaks cancer cells and keeps the immune system from destroying them. If a patient’s PD-L1 levels are above normal, that patient’s NSCLC may respond to a targeted immunotherapy.16
You and your oncologist should discuss biomarker testing before a biopsy is performed, so the doctor will know how much tissue to remove for the test.15 If the cancer continues to grow despite use of a targeted therapy, additional biomarker testing may be needed.15
Researchers continue to explore use of targeted cancer treatment, and their findings could soon expand the treatment’s role in treating NSCLC and other lung cancers.1 For example, researchers are investigating use of targeted agents for locally advanced, earlier-stage lung cancers.1 Newer treatments that target additional mutations also are being developed, and this could make targeted treatment available to many more patients with NSCLC.1
RCCA has more than 100 medical oncologists and hematologists who practice at 25 locations across New Jersey, Connecticut, Massachusetts, Maryland, and the Washington, D.C., area. RCCA’s cancer specialists see more than 30,000 new patients each year and provide care to more than 265,000 established patients, collaborating closely with those patients’ other physicians. RCCA physicians offer patients innovative therapies, including immunotherapies and targeted therapy, as well as access to approximately 300 clinical trials. In addition to serving patients who have solid tumors, blood-based cancers, and benign blood disorders, RCCA care centers also provide infusion services to people with a number of non-oncologic conditions—including multiple sclerosis, Crohn’s disease, asthma, iron-deficiency anemia, and rheumatoid arthritis—who take intravenously administered medications.
To learn more about RCCA, call 844-346-7222 or contact us today.
References
Cancer is the second-leading cause of death for all Americans, but it takes a particularly high toll on people of African and Caribbean ancestry.1 [Saka
Dr. Victor Aviles, a compassionate Cape Cod oncologist bringing hope and advanced cancer care to the community.
The 20th Annual Hope Music Fest, presented by the Hope Community Cancer Center division of Regional Cancer Care Associates (RCCA), returns for a night filled
Regional Cancer Care Associates is one of fewer than 200 medical practices in the country selected to participate in the Oncology Care Model (OCM); a recent Medicare initiative aimed at improving care coordination and access to and quality of care for Medicare beneficiaries undergoing chemotherapy treatment.
