Targeted therapy vs chemotherapy: which has had more impact on survival in lung cancer? Does targeted therapy make patients live longer? Hard to prove, but impossible to ignore.

Over the last few years, the use of molecular profiling to direct patients to specific targeted therapies has irrevocably changed how we treat lung cancer. Despite this, many randomized trials have failed to show an apparent survival advantage from this approach in stage IV disease. Are we using targeted therapy for no real benefit, lulled into a false sense of security by impressive radiographic responses—only to shorten the patient’s life later? Of course not, as anyone who treats lung cancer patients can tell by how the quality and quantity of our patients’ lives have improved in the last few years. Profound and durable responses now can be achieved in an increasing proportion of patients across a range of actionable abnormalities; historical trends and meta-analyses of trials all suggest the overall survival benefit is really there; and, when large populations are explored, key subsets of patients, who are likely to be the ones harboring the most actionable molecular markers, are now living longer than they did before targeted therapies were available. Is it easy to point to a single irrefutable piece of evidence proving the survival benefit of targeted therapy in lung cancer? No, but it is also impossible to ignore.