Paul A. Bunn Jr., MD, FASCO, Distinguished Professor and James Dudley Chair of Lung Cancer Research, University of Colorado Cancer Center, Aurora, Colorado, USA. 2016 David A. Karnofsky Memorial Award Winner
Lung cancer mortality rates for both men and women have been declining in recent years. Early detection, refined understanding of tumour biology, and a variety of novel treatment options have made these advances possible. Nevertheless, lung cancer is still the leading cause of cancer death in the United States and worldwide, prompting the scientific community to persevere in their research efforts and to extend them to areas that have traditionally been marked by little progress, such as small-cell lung cancer (SCLC).
At the Annual Meeting of the American Society of Clinical Oncology (ASCO) that took place in Chicago, 3rd–7th June, 2016, promising results were presented that have been achieved using immunotherapeutic approaches in the setting of SCLC. As in non-SCLC (NSCLC), it appears that a certain proportion of treated patients can hope for long-term survival. Also, phase I data on the DLL3-targeted antibody–drug conjugate rovalpituzumab tesirine suggest that it has clinically relevant activity in the SCLC population.
One quarter of the abstracts submitted for this year’s ASCO Congress were focussed on the topic of immunotherapy. According to updates of pivotal trials, sustained benefits can be expected in a minority of patients with these drugs. Combination immunotherapy consisting of nivolumab and ipilimumab may provide benefits over nivolumab monotherapy in advanced NSCLC of any histology. However, molecularly targeted therapies remain the preferred therapeutic choice in the first line for patients with driver alterations. ALK inhibitors such as alectinib and brigantinib have shown efficacy in tumours with ALK-resistance mutations, and the novel agents lorlatinib and olmutinib are being tested in ALK/ROS1– positive and EGFR-T790M-mutated NSCLC, respectively.
Continual refinement in the field of molecular diagnostics is a cornerstone of this evolution. According to a large analysis, targeted therapy conferred survival improvements when all driver mutations were considered. Minimally invasive techniques are gaining ground, due to their obvious advantages. The assessment of circulating tumour DNA, which is obtained through conventional blood sampling, enables profiling of solid tumours and adds to the accuracy of tissue typing.