Biomarker-directed therapies boost survival in metastatic NSCLC

  • Arbour KC & al.
  • JAMA
  • 27 Aug 2019

  • curated by Craig Hicks
  • Univadis Clinical Summaries
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Takeaway

  • Biomarker-directed therapies and newer empirical treatment regimens have improved survival in patients with metastatic NSCLC.

Why this matters

  • “Non-small cell lung cancer remains the leading cause of cancer death in the United States,” say researchers. “Until the last decade, the 5-year overall survival rate for patients with metastatic non-small cell lung cancer was less than 5%.”

Review methods

  • Researchers reviewed English-language articles reporting results from clinical trials of medical therapies for NSCLC that influenced current standards of care; they also reviewed guidelines from major professional societies.
  • Funding: National Cancer Institute.

Key observations

  • Advances in biomarker-directed therapy have improved 5-year OS by over 20% among patients with high programmed death-ligand 1 (PD-L1) expression and by over 35% among those with ALK-positive tumors.
  • All patients with metastatic NSCLC should undergo molecular testing for PD-L1 protein expression and mutations to support selection of systemic therapies.
  • About 30% of patients with NSCLC have molecular mutations that predict response to treatment; therapies that target such mutations improve PFS more than cytotoxic chemotherapy.
  • Patients without targeted mutations can benefit from immune checkpoint inhibitors, either as monotherapy or in combination with chemotherapy.

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