138IN - Personalized Therapy in Lung Cancer: The Promise for the Future

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ABSTRACT Chemotherapy has improved the outcome of patients with non-small cell lung cancer with prolonged survival rates in advanced disease and higher cure rates in combination with surgery or radiotherapy for earlier stages of disease. With the exception of maintenance therapy, the most recent advances have been achieved in patients with selected molecularly defined subgroups of non-small cell lung cancer. The area of personalized therapy for lung cancer started in the year 2004 with the identification of activating EGFR mutations in lung adenocarcinoma being associated with striking clinical responses to EGFR tyrosine kinase inhibitors. Subsequent clinical studies lead to the approval of EGFR tyrosine kinase inhibitors gefitinib and erlotinib as fist line therapy for this group of patients. These developments were followed by the discovery of ALK rearrangements as oncogenic driver for another subgroup of lung adenocarcinoma and the demonstration of selective activity of the tyrosine kinase inhibitor crizotinib. Since, the field has developed rapidly with the detection of other potentially actionable mutations and genetic rearrangements in lung adenocarcinoma and lung squamous cell carcinoma. The consequence – at present restricted to patients with advanced disease – it a transition from empiric clinical trials based on patient characteristics to molecularly-driven clinical trials and - in clinical practice - a transition from a standardized therapeutic approach to a personalized approach based on molecular tumor characteristics. There is evidence that the integration of EGFR tyrosine kinase inhibitors into the treatment of patients with tumors harboring an activating EGFR mutation is associated with more than a doubling of the time of survival as compared to treatment with chemotherapy alone – no doubt a significant clinical improvement. However, the fact remains, that eventually tumors become resistant also to targeted therapy. In consequence chemotherapy is likely to stay as a treatment option for the future and research into how to counteract resistance will gain in importance. The major challenge however will be on how to optimally deal with new the opportunities. How to move from standardized medicine to personalized medicine will become a priority issue in health care delivery. Disclosure The author has declared no conflicts of interest.