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Small cell lung cancer
CLINICAL PEARLS In practice, small cell lung cancer (SCLC) is classified using the Veterans’ Administration Lung Study Group system as either limited-stage, if all disease can be encompassed within one tolerable radiotherapy port, or extensive-stage. Genomically, SCLC is characterized by…
Immunotherapy
CLINICAL PEARLS In patients with no contraindications, immunotherapy monotherapy or its use as part of combination therapy is the mainstay of treatment in non−small cell lung cancer (NSCLC). Testing for PD-L1 expression is essential to help guide treatment decisions. Unlike…
Other molecular cohorts including ROS1, BRAF, HER2, MET, NTRK, RET, KRAS
CLINICAL PEARLS Molecular profiling of tissue is now recommended during the initial workup of advanced non–small cell lung cancer. Patients may be eligible for targeted therapies to driver mutations other than EGFR and anaplastic lymphoma kinase as early as first…
Diagnosis and treatment of anaplastic lymphoma kinase (ALK) rearranged non−small cell lung cancer
CLINICAL PEARLS Testing for ALK rearrangement can be performed by using immunohistochemistry, fluorescence in-situ hybridization, and next-generation sequencing. All patients with stage 4 non–small cell lung cancer with adenocarcinoma histology should be tested for an ALK rearrangement. Next-generation ALK tyrosine…
Epidermal growth factor receptor –mutated non–small cell lung cancer: a clinical approach
CLINICAL PEARLS All patients with advanced, nonsquamous, non−small cell lung cancer (NSCLC) should undergo epidermal growth factor receptor (EGFR) mutation testing as a part of a broader molecular panel (e.g., targeted next-generation sequencing panel). EGFR tyrosine kinase inhibitors (TKIs) are…
Second-line therapy in advanced non–small cell lung cancer
CLINICAL PEARLS For immunotherapy-naïve patients, second-line anti-PD-1/PD-L1 inhibitors are preferred over cytotoxic chemotherapy due to improved efficacy and tolerability. For patients with disease progression on first-line immunotherapy monotherapy, second-line cytotoxic chemotherapy with platinum doublet is appropriate. For patients with progression…
First-line therapy
CLINICAL PEARLS In advanced non−small cell lung cancer, when an actionable oncogenic driver is present, regardless of the PD-L1 tumor proportion score (TPS), targeted therapy is the preferred option. In the absence of an oncogenic driver, currently PD-L1 TPS drives…
Locally advanced non–small cell lung cancer
CLINICAL PEARLS Locally advanced non–small cell lung cancer (NSCLC) is a heterogeneous entity, which can be divided broadly into patients with resectable and unresectable disease. Select cases of locally advanced NSCLC (including superior sulcus tumors) are amenable to surgical resection,…
Oligometastatic disease
CLINICAL PEARLS Stage IV NSCLC is a heterogeneous disease, reflected in reclassifications seen in the eighth edition of the TNM staging system. Oligometastatic disease, described as an isolated metastasis or limited metastases in a single or limited number of organs,…