Current pharmacotherapy of non-small cell lung carcinoma
Absztrakt
Non-small cell lung cancer accounts for the majority of cases within the lung cancer family, and most patients often times are not clinically diagnose until late in the disease course mainly due to nonspecific early presentations and late clinical manifestations frequently caused by tumor related mass effect, paraneoplastic syndromes and metastasis to distance sites such as brain and bone. Surgery, radiotherapy, cytotoxic chemotherapy, targeted therapy, and immunotherapy are commonly used in the management of NSCLC, either as monotherapy or as combination regimen. In resectable cases, surgical intervention by video-assisted thoracoscopic surgery lobectomy approach is currently recommended for medically suitable early stages NSCLC patients with a curative intent. While in unresectable disease or in inoperable patients with early-stage NSCLC, stereotactic body radiation treatment is suggested due to decent local control and tolerable toxicity profile. Systemic cytotoxic chemotherapy with the standard platinum-based regimen in conjunction with other cell cycle inhibitors like taxanes or antimetabolites agents is often use in the management of unresectable disease, locally advanced, or metastasized stage of NSCLC. Improve understanding of NSCLC molecular subtypes have led to advance in biomarker-directed targeted therapies available for advanced metastatic NSCLC patients carrying specific genetic mutations; this results in improved overall survival in a significant proportion of patients with advanced disease. Since the introduction of immunotherapy like PD-1/ PD-L1 inhibitors, virtually all oncogenic driver negative NSCLC patients without targetable molecular gene alterations that are susceptible to therapies are recommend to receive treatment with one of these immunotherapy agents in the first-line setting; and the incorporation of immunotherapy have demonstrated a noticeable improvement in overall survival and progression-free survival in advanced metastatic NSCLC patients.