[Therapeutic advances in lung cancer]

Therapeutic advances in lung cancer. The molecular dissection of lung cancers led to the development of new oral targeted therapies, mainly kinase inhibitors, in 15% of non-small cell lung cancer patients of which tumors exhibit oncogenic activating mutations or gene translocations involving genes encoding for kinases. The overall survival of patients with such tumors with addictive gene alterations reaches several years with those kinase inhibitors nowadays, with new generation drugs in second or third-line settings, extending such survival by acting on resistance mutations emerging after first-line therapy. Individual screening of lung cancer using low dose CT-scanner in smoker patients aged 55-74 years, allows the finding of small stage IA cancer nodules, with long-term survival rates exceeding 80% at 5 years. For such small tumors, patients take advantage of minimally invasive surgery, such as sub-lobar resection, video-assisted thoracoscopic surgery (VATS) or robot-assisted thoracoscopic surgery (RATS). Such small tumors could also be cured by stereotactic ablative radiotherapy. At last, the monoclonal antibodies targeting immune checkpoint proteins, currently consist of the new therapeutic revolution in 20 to 30% of patients with tumors highly expressing the PD-1/PD-L1 proteins, with a plateau of long term survival, at the cost of immune side effects which do not significantly impair quality of life in most treated patients.