Update 2020: Management of Non-Small Cell Lung Cancer
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STATE OF THE ART REVIEW
Update 2020: Management of Non‑Small Cell Lung Cancer Mariam Alexander1 · So Yeon Kim2 · Haiying Cheng2 Received: 26 July 2020 / Accepted: 2 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The past decade has seen a revolution of new advances in the management of non-small cell lung cancer (NSCLC) with remarkable progresses in screening, diagnosis, and treatment. The advances in systemic treatment have been driven primarily by the development of molecularly targeted therapeutics, immune checkpoint inhibitors, and anti-angiogenic agents, all of which have transformed this field with significantly improved patient outcomes. This review will address updates in lung cancer screening, liquid biopsy, and immunotherapy in the front-line setting. We discuss recent advances and highlight the plethora of new approvals of molecular-targeted therapy for subgroups of NSCLC patients with sensitizing EGFR, ALK, ROS1, RET, BRAF V600E, MET, and NTRK alterations. Keywords Lung cancer · Immune checkpoint inhibitors · Targeted therapy
Introduction Lung cancer is the second most common cancer and the leading cause of cancer death in the USA. Approximately 247,270 new cases of lung cancer are estimated to occur in 2020, with 130,340 male cases and 116,930 female cases [1]. Prior studies have reported that lung cancer resulted in more deaths than breast cancer, prostate cancer, colorectal cancer, and leukemia combined in men ≥ 40 years old and women ≥ 60 years old. With the introduction of screening guidelines and decrease in tobacco use, the mortality rate for lung cancer has recently decreased by 48% in males and 23% in females. Despite this decrease in mortality rate, approximately 140,730 deaths are estimated to be secondary to lung cancer in 2020 [1]. The greatest risk factor for development of lung cancer is tobacco use. Secondhand smoking has also been shown to increase the risk of lung cancer by as much as 26% [2]. Other risk factors for lung cancer include asbestos exposure, family history of lung cancer, exposure to toxic substances including polycyclic aromatic hydrocarbons, heavy metals, * Haiying Cheng [email protected] 1
Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
2
and radon gas [2]. Long-term effects of electronic cigarettes are currently unknown, but mice exposed to electronic cigarettes were more prone to develop lung adenocarcinomas compared to mice exposed to control air [3].
Lung Cancer Screening The National Lung Screening Trial (NLST) showed a 20% reduction in lung cancer mortality with three annual lowdose computed tomography (CT) screenings for patients with high risk for lung cancer at a median follow-up of 6.5 years. Based on these results, the US Preventive Services Task Force (USPSTF) recommends annual screening in patients between the ages of 55 to 80 years with a smoking histo
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