New Advances in Non-small Cell Lung Cancer Management: Immune Modulation and Targeted Therapies

Three revolutions have, since the 1970s, modified the lung cancer management. Introduction of active conventional cytotoxic drugs, beginning with cisplatin and followed by second and third generation agents, led to substantial improvement in disease control and survival in stage IV non-small cell lung cancer (NSCLC), while cure rate increased with the addition of chemotherapy to local therapy in stage I-III NSCLC. The second revolution occurred when oncogenic driven mutations were discovered with subsequent, very effective small oral inhibitors with adequate toxicity profile. In a few years, targeted therapies have become available for EGFR and BRAF V600E mutations as well as ALK and ROS-1 translocations. The third revolution happened a few years ago. After decades of nihilism in immune modulation, immune checkpoints inhibitors demonstrated their effectiveness for salvage and currently for first-line treatment of unresectable advanced and metastatic NSCLC.

The therapeutic algorithms that were used in 2017 are now outdated. Considering targeted or immune therapies, whatever new drugs and combinations are regularly tested show short and long-term benefits for patients. The aim of this series is to provide an overview of the current knowledge in targeted therapies and immune modulation from bench to bedside. The concepts for which the current therapeutic strategies are based, the new drugs and combinations and the main pitfalls of these new and promising treatment will be exposed in this series of articles.