Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Systemic therapy treatment patterns in patients with advanced non-small cell lung cancer (NSCLC): PIvOTAL study

“…Discoveries of targetable gene mutations and the development of targeted therapies, as well as immunotherapies such as the programmed death‐1 (PD‐1) and PD ligand‐1 (PD‐L1) inhibitors, have contributed to changes in the management of NSCLC. The potential now exists for personalised therapy based on histology and biomarker findings, raising hopes of improved outcomes for patients with lung cancer (Novello et al., 2016). …”

Complications and Economic Burden Associated with Obtaining Tissue for Diagnosis and Molecular Analysis in Patients with Non-Small Cell Lung Cancer (NSCLC) in the US (Preprint)

“…When considering the use of targeted therapies for anaplastic lymphoma kinase (ALK)-rearranged and epidermal growth factor receptor (EGFR) mutation-positive NSCLC, tumor biopsy or blood-based testing is required to confirm tumor mutation status and assist with appropriate patient selection [3,12,13]. With the increase in availability of additional mutation-and translocation-based targeted therapies and immunotherapies, molecular and immune micro-environment testing at diagnosis and progression have become increasingly important to understand molecular mechanisms of resistance and for the effective management of NSCLC.…”

“…Based on positive results from the AURA trial program and FLAURA first-line study, osimertinib is recommended in the US as a first-line treatment option for patients with EGFR mutation-positive advanced NSCLC and as a second-line treatment for patients with T790M-positive NSCLC following disease progression on a first-line EGFR-TKI therapy (erlotinib, gefitinib, or afatinib) [12,19]. Thus, EGFR mutation testing at diagnosis and T790M testing following progression on an EGFR-TKI are now recommended in clinical guidelines and are standard of care in clinical practice [3]. Similarly, with multiple ALK-directed targeted therapeutics recommended for advanced lung carcinoma with ALK translocation [3], it is becoming increasingly important to biopsy upon progression to determine the mechanism of resistance and help inform subsequent therapeutic decisions [20].…”

“…Non-small cell lung cancer (NSCLC) accounts for 85% to 90% of all lung cancers [3]. Recently, the management of NSCLC has progressed towards personalized, biomarker-driven directed therapies designed to improve patient survival, safety, and quality of life.…”

“…Recent guidelines recommend a postprogression biopsy in patients with NSCLC to guide subsequent treatment decisions [3]. However, pre-guideline background data are limited on the frequency of post-progression biopsies performed in non-academic clinical practice to determine if a patient is eligible for additional targeted therapeutics.…”