Targeted Therapy in Non-Small Cell Lung Cancer

*Please note: This slide show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor about any questions you may have regarding a medical condition.

What is targeted therapy?

Targeted therapy is a cancer treatment directed towards specific mutations that drive cancer to grow and spread. Targeted therapies interrupt the growth and function of cancer cells, while avoiding healthy cells.

What is targeted therapy?

You may qualify for targeted therapy based on the results of biomarker testing that looks for known mutations driving non-small cell lung cancer (NSCLC). The tests look for specific molecular signs and substances that reveal a cancer's mutations.

What difference can targeted therapy make?

Experts recommend that everyone diagnosed with NSCLC have testing for the presence of driver mutations in the tumor as soon as possible.¹ This testing allows the doctor to prescribe treatment that is tailored to your individual cancer.

Targeted therapy offers hope for people with NSCLC. Many people live longer with targeted therapy.²

Why is biomarker testing so important?

The mutations that help NSCLC grow and thrive are called "driver" mutations. They drive cancer activity. Knowing your cancer's mutations allows you and your doctor to choose the best targeted therapy based on your cancer stage, general health, and preferences.

Biomarker testing for Stage I, II, and III

Experts recommend comprehensive biomarker testing, or at the least, testing for the more common driver mutations such as EGFR, ALK, KRAS, ROS1, cMET, RET, NTRK and BRAF V600E, as well as for levels of the protein, PD-L1, when you are first diagnosed with non-small cell lung cancer.³

Biomarker testing in Stage IV and other situations

Doctors also recommend testing for biomarkers if you have Stage IV NSCLC, your cancer spreads or returns after treatment, or you did not have biomarker testing at diagnosis.

Biomarker testing in Stage IV and other situations

Experts are studying new drugs based on other biomarkers. You may be able to join a clinical trial for a new medicine not yet available to the public.

Why is biomarker testing important for certain groups?

Biomarker testing is important for everyone, including people from certain groups, such as African Americans. In the past, lung cancer rates have been significantly higher in this group.

For example, African American men had higher rates of lung cancer than white men and were much more likely to die of it up until the recent past.⁴ This is changing, but the death rate and rate of new cancers is still higher in the African American community.

Importance of biomarker testing and targeted therapy for African Americans and other minorities

African Americans tend to be diagnosed at later stages of NSCLC and wait longer for treatment. This is especially true for African American men. This and other factors lead to lower survival rates than for White Americans.⁵ Biomarker testing can help more African Americans receive targeted therapies, which improves survival.

Some other minorities also tend to have higher lung cancer rates and receive less treatment. If you are American Indian, Alaska Native, or a Pacific Islander, be sure to ask your doctor about comprehensive biomarker testing.⁶

Targeted therapy for people with the EGFR mutation

Targeted therapies for specific mutations can be used as the first treatment, or first-line treatment, for NSCLC. They can also be used later as a second treatment, or second-line treatment.

As an example, for the EGFR mutation, the medicine osimertinib may be part of the first-line treatment. If the cancer grows with this treatment, doctors can prescribe other targeted therapies.

Targeted therapy for the ALK mutation

For the ALK mutation, first-line treatments are alectinib, lorlatinib, or brigatinib. If your treatment starts with alectinib or brigatinib, lorlatinib might be a second-line treatment.

It is important to repeat testing for driver mutations if the first-line treatment does not work, because the second-line treatment depends on the cancer's mutation profile at the time that it progresses.

Targeted therapy for the ROS1 mutation

Repotrectinib or entrectinib are the preferred first-line treatments for people with a ROS1 mutation, especially if the cancer has spread to the central nervous system.

Targeted therapy for the BRAF mutation

People with a mutation called BRAF V600E can receive a combination of two drugs, dabrafenib and trametinib. This may be a first- and second-line treatment.

Targeted therapy offers hope for NSCLC

If your doctor suspects lung cancer, ask about comprehensive biomarker testing. Experts recommend it for everyone with NSCLC.⁷

If you did not receive it, talk with your doctor about doing the tests now. Targeted therapy can make an important difference in your health outcomes.

References

1. Califf RM. Biomarker definitions and their applications. Exp Biol Med (Maywood). 2018 Feb;243(3):213-221.
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3. Lindeman NI, Cagle PT, Aisner DL, Arcila ME, Beasley MB, Bernicker EH, Colasacco C, Dacic S, Hirsch FR, Kerr K, Kwiatkowski DJ, Ladanyi M, Nowak JA, Sholl L, Temple-Smolkin R, Solomon B, Souter LH, Thunnissen E, Tsao MS, Ventura CB, Wynes MW, Yatabe Y. Updated Molecular Testing Guideline for the Selection of Lung Cancer Patients for Treatment With Targeted Tyrosine Kinase Inhibitors: Guideline From the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med. 2018 Mar;142(3):321-346.
4. Centers for Disease Control and Prevention. Leading cancer cases and deaths, all races and ethnicities, male and female, 2017.
   https://gis.cdc.gov/cancer/uscs/dataviz.html
5. American Cancer Society. Cancer facts & figures for African Americans 2019-2021. Atlanta, GA: American Cancer Society, 2019.
6. Ryan BM. Lung cancer health disparities. Carcinogenesis. 2018 May 28;39(6):741-751.
7. Garrido P, Conde E, de Castro J, Gómez-Román JJ, Felip E, Pijuan L, Isla D, Sanz J, Paz-Ares L, López-Ríos F. Updated guidelines for predictive biomarker testing in advanced non-small-cell lung cancer: a National Consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology. Clin Transl Oncol. 2020 Jul;22(7):989-1003.