Treatment of Advanced Non-Small Cell Lung Cancer in the Era of Targeted Therapy

Purpose of ReviewSince the identification of multiple mutations associated with advanced non-small cell lung cancer (NSCLC), many targeted therapies have been developed for the treatment of this subgroup of lung cancers. These targeted therapies have changed the landscape of lung cancer treatment when compared to standard chemotherapy, with improved survival and quality of life. In this review article, we will review the major mutations associated with advanced NSCLC, namely EGFR, ALK, and ROS1. We will discuss their discovery, their clinical significance, and the diagnostic tests used for their detection. We will also review the respective targeted therapies developed, and the clinical trials that led to their approval.Recent FindingsWe will also review the most recent advances in targeted therapies in the treatment of advanced NSCLC, including recent data on tyrosine kinase inhibitor osimertinib showing equal effectiveness to other first-line therapy and accordingly recommended in first line for EGFR-positive advanced NSCLC. We will discuss emerging targetable mutations such as HER2, RET, and MET.SummaryTargeted therapies will likely shape the future of NSCLC treatment. They have been shown to provide survival advantage over chemotherapy, while providing better quality of life through ease of administration (most are oral drugs), as well as tolerability and better toxicity profile. Further elucidation of these and mutations may provide for future more effective targeted therapies.