Lung Cancer Therapy; 2018 and Beyond

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 285

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LCPIMED03_006

تاریخ نمایه سازی: 5 آبان 1397

چکیده مقاله:

Iran The utilization of targeted immunotherapy in cancer treatment has dramaticallyimproved both the progression of disease and overall survival in patients, especially in patients withnon-small cell lung carcinomas (NSCLC). The advent of identifying specific gene mutations, sothat opportunities to use targeted therapy are uncovered, has transformed the way in whichphysicians approach disease prognosis.By understanding the intricate mechanics of the immune system and the way in whichcancer cells alter those mechanisms, cancer therapy can have a more focused course. One of thereasons that cancer cells can successfully evade the immune system is due to its ability to initiate aninhibitory signaling cascade. Immune-modulating biologics, such as CTLA-4 inhibitors and bothPD-1 and PD-L1 inhibitors, have successfully weakened the inhibitory effects of cancer cells on theimmune system. These positive responses to therapy are most apparent in patients who display PDL1expression on their tumor cells. Therefore, it is important for NSCLC patients to undergo PD-L1testing in order to recognize whether they would greatly benefit from the use of these newimmunotherapies.In addition, extensive research on therapeutic options for specific gene mutations, such asEGFR and ALK, has altered front-line therapy protocols. Many NSCLC patients are in advancedstages and present with metastases to the CNS. The introduction of a 3rd generation EGFR tyrosinekinase inhibitor (TKI), osimertinib, and 2nd generation ALK inhibitor (alectinib) has shown toimprove both progression free survival and overall survival rates in these patient populations, whilealso limiting adverse effects in comparison to both older generation TKIs and ALK inhibitors andchemotherapy. These alterations in front-line therapies are demonstrative of the advancements andtherapeutic benefits in identifying genetic disposition for NSCLC patients.Although immunotherapies have shown to be more efficacious than standard chemotherapyregimens in these patient populations, there are always adverse side effects from immunemodulation that must be continually monitored and corrected by the medical provider. The management of these toxicities is integral in the overall well-being of the patient, asoutweighing the risks versus benefits of therapies is a dynamic process in patient care.

نویسندگان

Houman Fekrazad

M.D, Associate Clinical Professor, Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, California, U.S.A