The latest progress in the treatment of non-small cell lung cancer

In the past decade, many advances have been made in the treatment of advanced non-small cell lung cancer (NSCLC), including: further understanding of the molecular biological mechanisms of lung cancer, identification of new oncogenes, and development of a number of new drugs targeting oncogenes. Targeted therapy against oncogenes using epidermal growth factor (EGFR) or anaplastic lymphoma kinase tyrosine kinase inhibitors has become the first choice for patients with EGFR activating mutations or anaplastic lymphoma kinase rearrangements.

1) EGFR targeted therapy

The first generation of EGFR TKIs, gefitinib and erlotinib, were not initially used to screen NSCLC patients, so their efficacy was modest compared with chemotherapy. Later studies found that somatic mutations in the tyrosine kinase region of the EGFR gene are oncogenic drivers for NSCLC, a finding that has prompted further clinical research.

2) ALK targeted therapy

Another important progress in the targeted treatment of NSCLC oncogenes is the identification of the rearrangement of the ALK gene, a discovery that has led to the creation of a series of new drugs (ALKTKI drugs). About four percent of NSCLC patients have ALK gene rearrangements, mainly adenocarcinoma, young patients, never smokers or light smokers, EGFR wild-type and male patients. Oral MET and ALK inhibitors crizotinib and ceritinib can improve the RR of patients with ALK rearrangement. A phase I expansion clinical trial for patients with ALK-positive advanced NSCLC showed that the RR of all patients was 60%, and the median PFS was 9.7 months; and the 24 patients who used crizotinib as first-line treatment had an encouraging median PFS of 18.3 months. This result was confirmed in the PROFILE1005 phase II clinical study.