Treatment for Non Small Cell Lung Cancer in Distinct Patient Populations

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Background

Pharmacotherapy for lung cancer has considerably changed in recent years. In the 2000s, the discovery of driver genes triggered the discovery of accurate predictors of the therapeutic efficacy of molecular-targeted drugs. Additionally, the effectiveness and safety of histological subdivision on angiogenesis depressants and new cytotoxic anti-cancer drugs have been shown in recent studies. Subsequently, a number of driver genes were discovered and molecular-targeted drugs were marketed. In this era, they have been classified based on genetic abnormalities. With the advent of immune checkpoint inhibitors and immune checkpoint molecules such as PD-L1, tumors are classified according to their expression of this protein, increasing the complexities in the algorithms of drug selection and molecular testing. The results of many important clinical trials led to the establishment of various treatment modalities, which have further resulted in better treatment choices.

Pharmacotherapy of lung cancer is being dramatically transformed by the development of biomarkers and novel pharmaceuticals. Traditionally, the 5-year survival rate for advanced non-small cell lung cancer has only been approximately 1%–3%. In contrast, among driver gene-positive patients, the median survival was approximately 3 years, and the 5-year survival rate extended to 30%. Even for cases without driver gene mutations, the advent of immune checkpoint inhibitors has resulted in more than 15% 5-year survival. However, these are the results of clinical trials and actual clinical practice includes patients that differ from the standard patient population used in clinical studies. There is little information available on the best treatments for distinct patient populations, such as those who exhibit poor performance status (PS), those who are elderly, and those with brain metastases, where the standard treatment regimens (e.g. platinum combination therapy or ICI with chemotherapy) appear unsuitable.

Thus, in this Research Topic, we aim to collect research tailored towards these distinct patient populations and discuss novel studies pinpointing special molecular subtypes of NSCLC. We particularly welcome Original Research and Review articles focusing but not limited to the following:

1. Better treatments for patients unfit for standard therapy;
2. Adverse events caused by treatments in distinct patients, such as those with poor performance status;
3. Prognostic predictors and novel treatment methods for distinct patients, especially those who exhibit brain metastases

Keywords: NSCLC, Tailored Treatment, Distinct Patients, Prognostic Predictors, Adverse Events

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