[Improved Outcomes in Resectable Advanced or Recurrent Lung Cancer]

Cytotoxic chemotherapeutic agents are defined by the AACR as traditional chemotherapy and have long been a mainstay of cancer treatment. Many of these drugs have been developed through screening natural substances. The efficacy of these drugs for non-small cell lung cancer was demonstrated by a 1995 meta-analysis, which showed an extension of survival time with cisplatin. Although numerous drugs have been developed, combinations such as carboplatin with paclitaxel and cisplatin with gemcitabine have been standard treatments. The development of molecularly targeted therapy represents a significant advance in the treatment of lung cancer, with EGFR inhibitors first approved in Japan. Predictive factors for therapeutic effect have been identified as specific abnormalities in the EGFR gene, and it has been shown that resistance due to secondary mutations in the gatekeeper region occurs, and that increasing specificity for genetic abnormalities enhances drug efficacy. Subsequently, genetic abnormalities causing multiple cancers have been identified, and corresponding drugs have been developed. Immunotherapy has shown the effectiveness of immune checkpoint inhibitors. In lung cancer, the therapeutic effect of PD-1/PD-L1 inhibitors was demonstrated early on. Currently, immunotherapy is standard treatment from the first-line for patients likely to respond well to it, and in combination with chemotherapy for others. Furthermore, as an adjunct to curative treatment, combinations of molecularly targeted therapy and immune checkpoint inhibitors have shown to extend survival. This indicates that a composite approach is beneficial for patient prognosis.