A cancer treatment plan is designed depending on the diagnosis of the cancer, the stage, and the individual’s overall health. Treatments fall under two general categories: systemic treatments which include chemotherapy, targeted therapy, and immunotherapy and local therapies such as radiation and surgery. The extent of the spread of disease is a major determinant of treatment options. While cancer that is localized to the lung is often amenable to surgical approaches, cancer that has spread to other organs generally requires therapies that distribute through the body.
Molecular Profiling of Lung Cancer
While lung cancer can be divided into histologic subtypes, it can also be defined at a molecular level by the “driver” mutations that occur in the DNA. Driver mutations occur in oncogenes, are not inherited, and are responsible for the onset of cancer by leading to activation of the cell cycle.
Treatment options have focused on targeting and inhibiting these mutations in efforts to prevent tumor growth or shrink the tumor. These targeted therapies have been approved for the treatment of NSCLC. Relatively common mutations include ALK and EGFR.
While abnormalities in ALK and EGFR have targeted approaches available, there are several other abnormalities that have potential available therapies either as part of research trials or with available drugs that are approved for other indications such as abnormalities involving Ros1, BRAF, HER2, MET or RET genes.
To combat acquired resistance to EGFR and ALK Tyrosine Kinase Inhibitor (TKI) treatments, second and third generation TKIs have been developed. These classes of drugs are designed to treat diseases that progressed after initially responding to first generation targeted therapies.
Some lung cancers can evade detection from the immune system by harnessing a pathway that prevents T-cells from recognizing cancer cells. PD-L1 is a protein on cells that can bind to the PD-1 protein on T-cells. This interaction prevents T-cells from trying to destroy the cells. Available immunotherapies block this pathway and allow T-cells to attack the cancer cells. The FDA has recently approved a PD-1 inhibitor as frontline therapy for those with PD-L1 positive (≥ 50) non-small cell lung cancer. As such, immunotherapy treatments have proven effective in a subset of the population and are currently a major focus of research. Currently, there are multiple approved immunotherapy treatments for lung cancer.
Lung Cancer Clinical Trial Program
TRIO-US currently offers a number of different treatment options for patients through clinical trials. For a comprehensive list of available clinical trials and for more information, please click (insert link).