الفهرس | Only 14 pages are availabe for public view |
Abstract In summary, the treatment of the lung cancer has advanced rapidly with the emergence of targeted therapy, immunotherapy, biomarker-based treatments, and availability of new clinical trials. Precision medicine may become increasingly important in the future of lung cancer treatment. Currently, testing for PD-L1 expression levels, EGFR mutations, ALK and ROS1 translocations are essential in selecting the best therapy for lung cancer patients, especially those with lung adenocarcinoma, large-cell histology, and non-small-cell lung cancer. Those tests can also be extended to patients who are never smokers or light smokers with squamous cell histology. Furthermore, broad genomic profiling to identify molecular alterations such as HER2 insertions, BRAF mutations, MET, TRK and RETalterations can help to identify investigational targeted agents that are in clinical trials For patients who are EGFR-positive, EGFR TKIs remain standard of care in the first-line metastatic setting. Patients with a ROS1 fusions should consider crizotinib as the initial treatment. For patients with ALK mutations, recent trials have shownthat the next-generation ALK inhibitor such as alectinib may be superior to crizotinib in the first-line setting. Patients whose tumors have high PD-L1 expression (_50%) should receive pembrolizumab as the first-line therapy. Ongoing clinical trials are evaluating the benefits of combining immunotherapy or targeted therapy with chemotherapy. Patients whose tumors harbor other mutationsshould be encouraged to participate in clinical trials for corresponding targeted agents. |