Molecular diagnosis and therapies for lung cancer (#144)
Non-Small cell Lung Cancer (NSCLC) as an entity has undergone a significant transformation in just over a decade. International collaboration has led to a new classification of adenocarcinoma, ensuring consistency in obtaining tissue and diagnosing subtypes. The molecular revolution is allowing us to not only sub-classify adenocarcinoma, but now also squamous carcinoma; and oncogenic driver mutations are identifiable in over 60% of adenocarcinomas and squamous carcinomas.
We have entered the era of adjuvant chemotherapy for resected node positive disease and have recognized through translational research prognostic markers and predictive markers of chemotherapy sensitivity.
The majority of NSCLC patients present with advanced or metastatic disease and we have moved fairly quickly from simply prescribing third generation (3G) platinum doublets of any type to all comers, to tailoring the 3G regimen according to histology.
With the development of small molecule inhibitors of receptor tyrosine kinases (nib’s), and through analysis of tissue from large randomized trials, the identification of specific point mutations of the Epidermal Growth factor driver mutations responsive to the “nib’s” have been characterized. New translocations that result in oncogenic signaling have also been found.
The era of targeted therapy is upon those who treat NSCLC and in the last year we have seen amazing results from publications using a more personalized approach to caring for patients whose diseases harbor specific mutations.
How do the multidisciplinary Lung Cancer teams outside of large research facilities manage the rapid changes? How should the Lung Cancer community in Australia advise the funders on what is needed to ensure all our patients have access to the best available diagnostics and therapy no matter where they live?
Paradigm shifts in medical practice need to encourage and guide paradigm shifts in health management and politics.