Personalized Medicine in NSCLC

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Obtaining tissue samples from individuals with lung cancer at initial diagnosis and relapse helps guide and personalize care, Roy S. Herbst, MD, PhD, states. Molecular testing can identify alterations in EGFR, ALK, ROS1, and BRAF, subsequently determining which therapies may be effective.

Approximately 20% of patients with non-small cell lung cancer (NSCLC) will have an actionable mutation. There are several therapies approved for the treatment of EGFR-mutant NSCLC and two targeted therapies approved for ALK-positive disease. For the remaining 80%, immunotherapies can be utilized, with research continuing to explore potential biomarkers, Herbst explains.

The ALK inhibitor crizotinib has also demonstrated promise in patients with NSCLC who harbor a ROS1 alteration. Treatment with crizotinib demonstrated an overall response rate of 72% and a median progression-free survival of 19.2 months. These data led the NCCN to include crizotinib in their lung cancer treatment guideline for ROS1-positive NSCLC. Additionally, in April 2015, the FDA granted a breakthrough therapy designation to crizotinib as a potential treatment for this population.

The phase III ALCHEMIST study is currently assessing the potential for these targeted therapies in the adjuvant setting, based on molecular information obtained from tissue extracted during surgery. Patients with ALK translocations will be treated with adjuvant crizotinib and those with EGFR mutations will receive erlotinib, explains Anne S. Tsao, MD.