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Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Advanced non-small-cell lung cancer: how to manage non-oncogene disease
Andrea De Giglio1,2, Alessandro Di Federico1, Chiara Deiana1
1Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Abstract:
The therapeutic approach to patients affected by advanced non-small-cell lung cancer (NSCLC) is facing rapid and continuous evolution. In recent years, the emergence of new treatment strategies, such as immunotherapy and tyrosine kinase inhibitors, has revolutionized the treatment algorithm and the prognosis of patients with NSCLC. In the non-oncogene-addicted disease, immune-checkpoint inhibitors, either as single agents or combined with chemotherapy, outperformed standard chemotherapy in both untreated and previously treated patients. However, many patients still do not derive the expected benefit from current treatments. Despite representing the only biomarker currently used in clinical practice to guide treatment selection, PD-L1 expression has been proven an imperfect predictor of immunotherapy outcomes. The evaluation of clinical factors remains essential to detect patients that would benefit the most from a particular treatment approach, but the identification of additional biological and molecular predictive tools is a priority. Herein, we provide a comprehensive though concise review of the current treatment approaches to advanced NSCLC in patients without molecular driver alterations, with an additional focus on special populations, concomitant medications, and other considerations that might be useful for daily clinical practice.
Insights
Advanced non-small-cell lung cancer (NSCLC) treatments are evolving rapidly with immunotherapy and tyrosine kinase inhibitors. Identifying predictive biomarkers beyond PD-L1 is crucial for optimizing patient benefit in NSCLC care.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Advanced non-small-cell lung cancer (NSCLC) treatment is rapidly evolving.
- Immunotherapy and tyrosine kinase inhibitors have revolutionized NSCLC care.
- Current treatments, including immune-checkpoint inhibitors, show limitations in patient response and PD-L1 as a sole predictive biomarker.
Purpose of the Study:
- To review current therapeutic strategies for advanced NSCLC in patients without molecular driver alterations.
- To highlight the importance of clinical factors and the need for novel predictive biomarkers.
- To provide practical considerations for daily clinical practice.
Main Methods:
- Comprehensive literature review of recent advancements in NSCLC treatment.
- Analysis of immunotherapy, tyrosine kinase inhibitors, and chemotherapy efficacy.
- Discussion of predictive biomarkers, including PD-L1 expression limitations.
Main Results:
- Immune-checkpoint inhibitors (ICIs) combined with chemotherapy or as single agents show superior outcomes compared to standard chemotherapy in NSCLC.
- PD-L1 expression is an imperfect predictor of immunotherapy response.
- Clinical factors are essential, but additional predictive tools are needed.
Conclusions:
- Optimizing treatment for advanced NSCLC requires moving beyond PD-L1 to identify patients who will benefit most.
- Further research into novel predictive biomarkers is a priority.
- A multidisciplinary approach considering special populations and concomitant medications is essential for effective NSCLC management.
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