P. Germonpré

Second-line treatment of non-small cell lung cancer adenocarcinoma patients not harbouring an oncogene driver mutation anno 2017–2018: A consensus group meeting

Summary

The treatment landscape for patients with advanced non-small cell lung cancer, who do not harbour an oncogenic driver abnormality, has changed dramatically over the last years. Second-generation antiangiogenic agents, such as nintedanib and ramucirumab, and particularly PD-1/PD-L1 inhibitors, such as nivolumab, pembrolizumab and atezolizumab have shown to prolong survival in pretreated non-small cell lung cancer patients. Immune checkpoint inhibition in the treatment of advanced non-small cell lung cancer comes with the promise of durable responses in responding patients. Nevertheless, one must appreciate that the average response rate seen with these PD-1/PD-L1 targeting agents is only about 20%. While PD-L1 testing may be used as an enrichment biomarker, a substantial proportion of patients still do not benefit from these agents. They could benefit from alternative therapeutic options, including novel anti-angiogenic agents. In this paper, a treatment algorithm is proposed that aims to optimise the second-line treatment choice for patients with lung adenocarcinoma, based on the available clinical data.

(BELG J MED ONCOL 2018;12(2):61–66)

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Immuno-oncology in lung cancer

Cancer immunotherapy consists of a number of approaches that aim to utilize the power of the immune system to combat the cancer by producing activated tumour-specific cytoxic T-cells (CTL) that are able to eradicate the antigen-bearing tumor cells. Cancer immunotherapies can be divided in (i) active immunotherapies aiming to mount an immune response to one or more tumour-associated antigens (i.e. cancer vaccines), (ii) passive immunotherapies relying on the administration of exogenously produced tumor antigen-specific lymphocytes or antibodies and (iii) immunomodulatory approaches that try to amplify the anticancer immune response by blocking the down-regulation of the adaptive immune system (i.e. checkpoint inhibitors). This brief overview will focus on those cancer immunotherapies for which survival data in lung cancer are available from large randomized controlled trials.

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Treatment of non-small cell lung carcinoma with gefitinib: a case report

Targeted therapy for non-small cell lung carcinoma (NSCLC) is a possible treatment option for patients with tumours expressing an activating mutation of the epidermal growth factor receptor (EGFR). Gefitinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) that was approved for treatment of EGFR mutation-positive NSCLC in Europe in 2009. In Belgium, gefitinib was only approved as a monotherapy for EGFR mutation-positive NSCLC stage IIIB-IV, whatever the line of treatment. When treatment was initiated, limited data were available relating to the use of TKIs for treating Caucasian patients with EGFR mutation-positive NSCLC. Thus, information on EGFR TKI use, in the real-life clinical setting and particularly in Caucasian patients and patients with brain metastases is still needed. Here, we report the case of a patient with NSCLC and brain metastases being treated with gefitinib.

After twelve months of treatment, the chest and brain scans still showed improvement with lung function normalising and the patient reporting a good quality of life. As this patient was not previously treated with chemotherapy, there is still an opportunity of treating her later, when the tumour becomes resistant to gefinitib, with cisplatinum-pemetrexed. This is still possible because she remains chemotherapy-naive, which is required to request reimbursement in Belgium of that type of chemotherapy. (BELG J MED ONCOL 2012;6:169–175)

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