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Editor in ChiefThe Resource Centre “Milestones in non-small-cell lung cancer” owes its title to the tremendous progress that has been made in the treatment of advanced non-small-cell lung cancer with targeted therapy and immunotherapy. Remaining knowledge gaps include the approach to take in patients insensitive to immunotherapy as well as the lack of standardization with regard to trial strategy and design. This interview with Prof. Solange Peters, Medical Oncology Service Chief, Oncology Department, University Hospital of Lausanne, Switzerland, reviews these topics.
Managing EditorThe regulation of tobacco control, immunotherapy, and targeted therapy in ALK- and KRAS-rearranged lung cancer were some of the highlights at the World Conference on Lung Cancer 2016 in Vienna, says Dr. Zimmermann, Senior Resident in Medical Oncology at Fribourg Hospital, Switzerland. He and the other editors of the Resource Centre “Milestones in non-small-cell lung cancer” invite you to visit this platform to keep abreast of recent scientific developments in this area.
Welcome & Introduction" by Nicholas ThatcherNicholas Thatcher introduces the symposium topic: “Debating the optimal management in advanced and metastatic lung cancer: The right treatment for the right patient at the right time”.
'Identifying the right patient: histological and molecular profiling challenges' by Keith KerrWith more insights into the molecular characteristics of lung cancer cells and the evolvement of new technologies diagnosis and treatment is more targeted and equally complicated – a lecture of Keith Kerr, University of Aberdeen.
"Maximizing Treatment Outcomes in Patients with Advanced Metastatic Lung Cancer" by Giorgio V ScagliottiGiorgio Scagliotti builds a modern-day algorithm for selecting individualized therapies in nonsquamous non-small cell lung cancer and squamous non-small cell lung cancer based on molecular biomarkers and clinical trial results. He highlights the improvements in our abilities to better target therapies but also addresses the limitations in translating clinical trial data to the clinical setting, and discusses the gaps in therapy that still remain in this patient population. Finally, he comments on the issues remaining with effectively incorporating immunotherapy strategies into the clinic.
"The right time, the right sequence" by Nicholas ThatcherUsing a case study in a 76-year old male with squamous non-small cell lung cancer, Dr Thatcher explores the significance of clinical trial results from a clinician’s perspective versus those of a patient. He suggests that while a 6-week increase in overall survival may be considered to be a minimal improvement by clinicians, to the patient it could mean a great deal. He also challenges the guidelines that currently define the age that is “too old” for chemotherapy, citing evidence that in people over 70 years of age chemotherapy can have substantial benefits.
"Medical management of advanced NSCLC" by Christian ManegoldThree antiangiogenic agents have been incorporated into current treatment algorithms for non-small cell lung cancer (NSCLC). Dr Manegold reviews clinical trial data that supports the addition of these agents to platinum-based chemotherapy, as well as the addition to other targeted agents such as monoclonal antibodies or small tyrosine kinase inhibitors. He discusses early results from small clinical trials that combine antiangiogenic agents with immune-checkpoint inhibitors. He also explores the questions that remain for creating a treatment algorithm for combining antiangiogenic agents with immune-checkpoint inhibitors for NSCLC therapy.
Advisory EditorBiomarker testing has opened the door for precision medicine based on an individual patient’s tumor characteristics rather than histology alone. Key biomarkers in patients with advanced non-small-cell lung cancer are epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) gene rearrangements, KRAS mutations or programmed death-ligand 1 (PD-L1) expression. Limitations to this approach, e.g. the sensitivity of the diagnostic tools or tissue availability, should be overcome by modern molecular technologies.
Advisory EditorImmunotherapy with nivolumab and pembrolizumab or a combination therapy have shown improvements in the survival of patients with squamous non-small-cell lung cancer. With many immunotherapeutic agents in the developmental phase, assigning patients to the best therapy will become ever more important and challenging.
- This session focuses on the overall landscape of ALK inhibitors for treatment of NSCLC. Enriqueta Felip, Head of the Medical Oncology Service of the Thoracic Tumors Committee, Vall d’Hebron University Hospital, Barcelona, Spain, discusses the various ALK inhibitors currently available, including crizotinib, ceritinib and alectinib, as well as the possible treatment modalities with these drugs either as monotherapy or in combination. She also provides a brief overview of the various randomized trials which have shown positive results with these inhibitors and stresses the need for further trials in order to obtain more data in this area.