Silvia Novello, MD, PhD, University of Turin, Italy
According to an estimate by the World Health Organization, 1.37 million people worldwide die of lung cancer every year. Both incidence and lung-cancer–related mortality are substantial: to date, primary lung cancer remains the most common malignancy after nonmelanocytic skin cancer, and the global numbers of patients dying from it exceed those linked to any other malignancy.
However, profound changes have been a notable development with respect to lung cancer over the last years. For one thing, shifts with regard to histology can be observed across the globe. The proportion of patients with small-cell lung cancer has been decreasing in frequency in many countries over the past two decades. Nonsmall lung cancer has undergone transformation concerning the relative importance of its predominant subtypes during the same period. In the USA, squamous cell carcinoma has decreased, while adenocarcinoma has increased in both genders. Similar trends apply to European men, while in women, both squamous-cell carcinoma and adenocarcinoma are currently on the rise.
Of course, from a clinician’s point of view, therapeutic innovation is the more spectacular part of lung-cancer–related changes. Novel approaches address targets that are not confined to the tumour cell, which had been at the centre of treatment considerations for a long time. Once again, immunotherapy was a hot topic at the ESMO 2016 Congress that took place in Copenhagen from 7th to 11th October. Renowned speakers presented four late-breaking abstracts on immunotherapeutic agents in advanced lung cancer at the second Presidential Symposium, which drew throngs of congress attendees. The results of these trials are presented in this publication, along with other findings in the field of immunotherapy.
Meanwhile, research has been ongoing with regard to druggable genetic aberrations within the tumour cell. Tyrosine kinase inhibitors like vandetanib and lenvatinib have shown promising clinical activity in RET-positive tumours, and convincing results were obtained with the next-generation ALK inhibitors ceritinib, alectinib and brigatinib. Recent insights into the EGFR landscape shed light on the refined use of EGFR-targeted drugs. At the same time, patients with small-cell histology find themselves entitled to share in the benefits conferred by molecularly targeted therapy. Aurora kinase A inhibition is a promising approach here, as is the PD- L1 antibody atezolizumab. Finally, the disruption of tumour angiogenesis contributes to tailoring treatment to each patient’s needs. Individualised therapy has become a reality for the benefit of a large number of present and future patients.