Lung cancer articles within Nature Reviews Clinical Oncology

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  • News & Views |

    Treatment of locally advanced non-small-cell lung cancer (NSCLC) in the elderly is challenging, with many available treatment options from radiotherapy alone to sequential chemoradiation. The latest phase III trial comparing radiotherapy alone with concurrent chemoradiation reported a survival improvement for the combination; however, this does not define a new standard treatment.

    • Cesare Gridelli

  • Review Article |

    Crizotinib has provided dramatic and prolonged benefit for patients with the ALK-positive subtype of non-small-cell lung cancer. Despite these early successes, many challenges remain including understanding the mechanisms of resistance to crizotinib. This Review examines what we already know and the major emerging questions associated with optimal management of this disease.

    • D. Ross Camidge
    •  & Robert C. Doebele

  • Review Article |

    DNA repair as a therapeutic target has received considerable attention in the treatment of non-small-cell lung cancer (NSCLC). In this Review, Postel-Vinay et al. discuss how optimizing treatment of NSCLC according to DNA-repair biomarkers, such as ERCC1, BRCA1 or RRM1, may aid clinical decision making and improve the outcome of patients with NSCLC.

    • Sophie Postel-Vinay
    • , Elsa Vanhecke
    •  & Jean-Charles Soria

  • News & Views |

    Elderly patients have often been excluded from, or under represented in, clinical trials. Now, a phase III trial has demonstrated that a platinum-based doublet regimen provides superior outcomes in elderly patients with advanced-stage non-small-cell lung cancer, and should be considered for palliative chemotherapy in this group of patients.

    • Robert Pirker

  • News & Views |

    Large randomized phase III trials conducted in patients with non-small-cell lung cancer (NSCLC) harboring activating mutations in EGFR have demonstrated that erlotinib or gefitinib are superior to platinum-based chemotherapy. Zhou et al. have now confirmed that these agents represent the best treatment we can offer today as front-line therapy for EGFR-mutant NSCLC.boxed-text

    • Lorenza Landi
    •  & Federico Cappuzzo

  • Review Article |

    Personalized medicine in lung cancer has seen great advances in the past decade. In this Review, Tony Mok examines the development of drugs that target mutations inEGFR and the oncogenic fusion gene EML4–ALKas examples of this progress and discusses the necessary tools to improve the chance of future successes.

    • Tony S. K. Mok

  • Review Article |

    Small-cell lung cancer has a poor prognosis and treatment options for this disease are limited. The authors discuss the molecular biology and current clinical management of progressive small-cell lung cancer, and critically evaluate the recent SPEAR trial, in which the use of second-line picoplatin was investigated.

    • William N. William Jr
    •  & Bonnie S. Glisson

  • Review Article |

    The existence of a state of limited metastasis or oligometastasis observed in selected patients is associated with favorable outcomes. This Review discusses the role of local therapy for oligometastases that arise in lung and liver, the challenge of identifying the patients who will benefit from the treatment of their oligometastatic disease and how to select the right local therapy for these patients.

    • Simon S. Lo
    • , Susan D. Moffatt-Bruce
    •  & Robert D. Timmerman

  • News & Views |

    Mediastinal staging of patients with lung cancer is used to avoid futile thoracotomies. Endoscopic, esophageal and bronchial ultrasound procedures are methods to identify involved lymph nodes. The ASTER study indicates that the sensitivity of these new techniques is high, reducing the number of futile thoracotomies and improving outcomes when combined with mediastinoscopy.

    • Paul Baas

  • Year in Review |

    Advances in non-small-cell lung cancer over the past decade have resulted in new treatments with minimal toxic effects and dramatic clinical benefits. 2010 saw continued advancement in our understanding of the molecular genetics of lung cancer and of specific targeted inhibitors with remarkable clinical benefit in selected populations.

    • Christine M. Lovly
    •  & David P. Carbone

  • News & Views |

    The optimal chemotherapy regimen to be used concurrently with thoracic radiation for locally advanced non-small-cell lung cancer remains uncertain. Studies investigating this question are ongoing.

    • Allen M. Chen
    •  & Primo N. Lara Jr

  • News & Views |

    Two meta-analyses of the Non Small Cell Lung Cancer Meta-analyses Collaborative Group (NSCLC MACG) on the effects of adjuvant chemotherapy on early stage NSCLC after complete or curative resection have demonstrated that adjuvant cisplatin-based regimens are a valid and recommendable option following curative surgery. We discuss these results in the light of current interdisciplinary guidelines and existing meta-analyses of randomized clinical trials.

    • Martin Stuschke
    •  & Christoph Pöttgen

  • News & Views |

    The ZODIAC trial reported that the addition of vandetanib to docetaxel in second-line treatment of unselected patients with metastatic non-small-cell lung cancer resulted in a statistically significant improvement in progression-free survival compared with docetaxel alone. Identification of biomarkers to assist in molecular selection of patients for targeted therapy is a tool for 'smart' clinical trial design.

    • Amanda Psyrri
    •  & Barbara Burtness

  • News & Views |

    A clinical trial of patients with pharmacogenomically selected non-small-cell lung cancer clearly demonstrated an improvement in progression-free survival after gefitinib treatment compared with standard chemotherapy. This report is the first to suggest that personalized therapy based on pharmacogenomics could be standardized in the treatment of lung cancer.

    • Nagahiro Saijo

  • News & Views |

    A phase III trial investigated the efficacy of carboplatin and a taxane with and without cetuximab, a monoclonal antibody against EGFR, in patients with advanced non-small-cell lung cancer. This trial did not reveal an improvement in the primary end point of progression-free survival (according to an independent radiological review committee) with the addition of cetuximab to the carboplatin and taxane regimen. A retrospective investigation of potential biomarkers did not reveal any significant association between these biomarkers and cetuximab efficacy.

    • Thomas E. Stinchcombe
    •  & Mark A. Socinski

  • News & Views |

    Platinum-based chemotherapy has been the standard first-line treatment for patients with advanced non-small-cell lung cancer for decades. However, a recent study has shown the superiority of gefitinib treatment in comparison with chemotherapy in a molecularly selected cohort of patients harboring sensitizing EGFR mutations. These results demonstrate the importance of incorporating molecular selection into the design of lung cancer trials that use EGFR tyrosine kinase inhibitors.

    • Ariel Lopez-Chavez
    •  & Giuseppe Giaccone

  • Review Article |

    Survival outcomes for advanced or metastatic non-small-cell lung cancer remain poor; however, molecular targeted agents offer new opportunities provided that patients are selected for treatment according to their tumor profile. This Review highlights the promising activity shown with novel targeted therapies that interfere with the IGF-1R pathway and agents that inhibit the EML4-ALK fusion protein. Aberrations in other key signaling pathways that have been identified as crucial targets, especially in resistant patients, are also discussed.

    • Filip Janku
    • , David J. Stewart
    •  & Razelle Kurzrock

  • Review Article |

    Well-developed and validated genomic signatures can lead to personalized treatment decisions resulting in improved patient management. However, the pace of acceptance of these signatures in clinical practice has been slow because many of the signatures have been developed without clear focus on the intended clinical use, and proper independent validation studies establishing their medical utility have rarely been performed. The authors of this Review focus on guidelines that physicians could refer to when evaluating studies on prognostic gene-expression signatures.

    • Jyothi Subramanian
    •  & Richard Simon

  • News & Views |

    Disappointing phase III results for thalidomide combined with gemcitabine and carboplatin in patients with advanced non-small-cell lung cancer might be related to poor efficacy of targeted therapies in unselected patients. We argue that current trial designs are flawed because they expose large numbers of such patients to potentially harmful treatment, and suggest that future research strategies should prioritize identification of predictive markers.

    • Martin Reck
    •  & Ulrich Gatzemeier

  • News & Views |

    Chemotherapy options for patients with extensive-stage small-cell lung cancer (SCLC) are limited. A recent phase III trial assessed the combination of carboplatin and pemetrexed but this regimen produced inferior survival results compared with the standard carboplatin and etoposide regimen. The combination of carboplatin and etoposide remains the standard first-line chemotherapy option for the treatment of patients with extensive-stage SCLC.

    • Janakiraman Subramanian
    •  & Ramaswamy Govindan

  • News & Views |

    Activating mutations in EGFR are characteristic of patients with lung cancer who have high sensitivity to EGFR tyrosine kinase inhibitors, such as gefitinib and erlotinib. The randomized IPASS study by Mok and colleagues confirmed that patients with EGFR mutations have a higher response rate, longer progression-free survival and improved quality of life when treated with first-line gefinitib instead of chemotherapy.

    • Joel W. Neal
    •  & Lecia V. Sequist

  • News & Views |

    Patients with stage III non-small-cell lung cancer (NSCLC) comprise a heterogeneous population; the role of surgical resection in this setting has been controversial. Albain and colleagues recently demonstrated that trimodality therapy with lobectomy had clinical benefit for patients with pathologic nodal N2 stage III NSCLC. We discuss the trial and its implications for future lung cancer therapy.

    • Anne S. Tsao
    • , Jack A. Roth
    •  & Roy S. Herbst

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