Abstract
Non-small cell lung cancer (NSCLC) is a heterogeneous disease, and therapeutic management has advanced with the identification of various key oncogenic mutations that promote lung cancer tumorigenesis. Subsequent studies have developed targeted therapies against these oncogenes in the hope of personalizing therapy based on the molecular genomics of the tumor. This review presents approved treatments against actionable mutations in NSCLC as well as promising targets and therapies. We also discuss the current status of molecular testing practices in community oncology sites that would help to direct oncologists in lung cancer decision-making. We propose a collaborative framework between community practice and academic sites that can help improve the utilization of personalized strategies in the community, through incorporation of increased testing rates, virtual molecular tumor boards, vendor-based oncology clinical pathways, and an academic-type singular electronic health record system.
Highlights
Lung cancer remains the leading cause of cancer deaths in the United States and, in 2020, it will be responsible for an estimated 230,000 cases and 135,000 deaths in the US alone [1]
Non-small cell lung cancer (NSCLC) is the major histological subtype that accounts for approximately 85% of all lung cancer cases and encompasses several subtypes, including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma [2]
We previously showed in a retrospective study that in a cohort of 253 patients from nine community practice centers, the molecular testing rate for first-line treatment decisions was 81.75%, with testing for programmed death-ligand 1 (PD-L1) at only 56% [29]
Summary
Lung cancer remains the leading cause of cancer deaths in the United States and, in 2020, it will be responsible for an estimated 230,000 cases and 135,000 deaths in the US alone [1]. We previously showed in a retrospective study that in a cohort of 253 patients from nine community practice centers, the molecular testing rate for first-line treatment decisions was 81.75%, with testing for PD-L1 at only 56% [29]. This suggests that while community sites are on pace to improving their testing rates, the current results are inadequate and require more education and understanding of novel upcoming personalized therapies. The purpose of the current review is to shed light on the available and upcoming therapies in lung cancer, to report the gaps in community practice testing rates, and to identify the available tools that can assist in complex lung cancer management and decision-making
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