“My Patient Was Diagnosed With Nontargetable Advanced Non–Small Cell Lung Cancer. What Now?” Diagnosis and Initial Treatment Options for Newly Diagnosed Patients With Advanced NSCLC

Although lung cancer remains the leading cause of cancer-related mortality in the United States and worldwide, the rate at which Americans are dying from lung cancer continues a decline that started in the 1990s. The primary reasons behind this improvement are reduced rates of tobacco use and the early impact of screening as well as a growing understanding of the underlying biology of NSCLC. Instead of one disease with one modestly effective treatment (platinum doublet chemotherapy), we now think of multiple distinct subtypes defined by a variety of biomarkers with different treatment algorithms.1 There have now been 13 new drugs approved for NSCLC in the last 5 years.2 The recommended roles of these drugs as well as the biomarker testing to guide their use continues to evolve, making it difficult for many practitioners to keep up.3,4 For the first time, phase III trials for biomarker-defined subsets of newly diagnosed patients with advanced NSCLC are showing unprecedented survival times (for example, in patients whose tumors harbor EGFR mutations treated with osimertinib or patients whose tumors express PD-L1 at high levels [tissue proportion score (TPS) more than 50%] treated with pembrolizumab).1,5 However, these patients are first identified for novel therapy through appropriate and timely diagnosis and biomarker analysis. In this review, we will first describe the recommended initial workup for a patient with advanced or metastatic NSCLC in 2018; next, we present an algorithm to aid oncologists in the selection of the most appropriate therapy for treatment-naive patients with NSCLC, and, finally, we offer a look into future treatment options through a discussion of ongoing clinical trials. DIAGNOSTIC APPROACH FOR PATIENTS WITH SUSPECTED LUNG CANCER Section: ChooseTop of pageAbstractDIAGNOSTIC APPROACH FOR P... <