Nathan A. Pennell, MD, PhD
Reflecting on the past 20 years of advances in non–small cell lung cancer (NSCLC), I am struck by how long a period went by with so little progress. Of course, today NSCLC treatment is changing at a breakneck pace, with new advancements presented at seemingly every major meeting and newly approved drugs emerging multiple times per year. However, not that long ago, NSCLC treatment was anything but exciting, and it took a completely different way of thinking about this disease to make today’s advances happen.
and that these types of tumors benefited from up-front genetic testing because targeted treatments worked much better than one-size-fits-all chemotherapy.
In the most recent decade—really, the past 6 to 7 years—we have seen an acceleration of discovery in NSCLC, primarily driven by our understanding that there are many types of lung cancer. Ubiquitous pie charts split NSCLC into multiple pathologic, genetic, and biomarker-defined groups that now must be determined before a course of therapy can be chosen. At least 4 genetic tests (EGFR, ALK, ROS1
, and BRAF
) should be run on every lung adenocarcinoma case, with more waiting in the wings (I see you, MET
). PD-L1 immunohistochemical testing identifies which patients would benefit from immune checkpoint inhibitors as monotherapy or if combination chemoimmunotherapy would be the best choice.
with some living beyond 5 years and possibly being cured. We still have a long way to go, but at the current pace of discovery I can’t wait to see what the next 20 years hold!
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