Brain metastases occur in approximately 35 % of patients with metastatic NSCLC and are associated with a variety of neurological symptoms, as well as poor prognosis. However, little is known about the prognostic impact of the symptomatic burden of CNS lesions at the time of diagnosis. This was assessed by an analysis based on a real-life cohort of 1,608 NSCLC patients from the Vienna Brain Metastasis Registry with newly diagnosed brain metastases.

Oncogene-directed treatment requires molecular testing, but, as is known, limitations related to tissue collection and tissue-based testing can represent a serious obstacle in clinical practice. Blood-based next generation sequencing (NGS) has the potential to overcome some of these limitations.

In the setting of non-squamous advanced NSCLC without actionable driver mutations, the advent of immune checkpoint inhibitor therapy has led to the implementation of new standards. Synergistic effects can be expected from anti-angiogenic treatment. The vascular endothelial growth factor (VEGF) has been shown to create an immunosuppressive tumor microenvironment by modifying immune cell function besides promoting angiogenesis.

In patients with untreated EGFR-mutant tumors, it has been shown that the addition of the anti-VEGF antibody beva­cizumab to first-generation EGFR TKIs induces PFS benefits with an acceptable toxicity profile. The open-label, randomized, multicenter, phase III ARTEMIS (CTONG 1509) study is the first phase III trial to test bevacizumab plus erlotinib in Chinese NSCLC patients.

In patients with advanced, EGFR-positive NSCLC, EGFR tyrosine kinase inhibitors (TKIs) represent the frontline treatment standard. Three generations of TKIs are widely available, but the ideal sequence is currently unknown. The phase III, double-blind, randomized FLAURA trial compared the third-generation EGFR TKI osimertinib with the first-generation agents gefitinib and erlotinib in the frontline setting.

The randomized phase III IMpower110 trial is evaluating the PD-L1 inhibitor ate­zolizumab as first-line treatment in patients with stage IV, PD-L1–positive non-small-cell lung cancer (NSCLC) independent of tumor histology. Patients in the experimental arm are treated with atezolizumab until disease progression, while the platinum-based chemotherapy regimens administered in the control arm for 4 to 6 cycles depend on histology.

The struggle against the devastating consequences of lung cancer is ongoing at many levels and appears to have reached important milestones, including effective combinations of novel drug classes and the targeting of an increasing number of driver aberrations. Immunotherapy was again a major aspect at this year’s annual congress of the European Society for Medical Oncology (ESMO) that took place at Barcelona, Spain, from 27th September to 1st October.