Population-Based Outcomes in NSCLC

摘要

A nihilistic approach to the treatment of non-small cell lung cancer (NSCLC) has characterized the predominant attitude of physicians as well as patients during most of my professional career. This attitude has persisted despite therapeutics that have demonstrated efficacy in terms both of quality and quantity of life since at least the early 1990s ( ). The level of benefit and the trade-off in terms of toxicity has improved remarkably in the past 25 years. During this time, we have seen several key developments. The first has been the development of very effective antiemetic therapies with 5HT3 serotonin blockade, neurokinin 1 antagonists, and other agents that have made “traditional” platinum-based therapies more tolerable and have moved the site of treatment from the inpatient to the outpatient setting. Second, the reemergence of histology as a predictive marker for therapeutics (pemetrexed and bevacizumab) has resulted in a higher likelihood and duration of benefit from cytotoxic treatments. Third, the discovery of specific activating mutations responsive to tyrosine kinase inhibitors (interestingly, a result of clinical observation rather than laboratory discovery) and the widespread availability of genetic testing have allowed for the introduction of agents with the potential to benefit 80–90% of the patients undergoing therapy. Most recently, the introduction of immunotherapeutics has completely altered the landscape of therapy with the rapid introduction of four new agents in a variety of settings and combinations in NSCLC that substantially improve outcomes with acceptable levels of toxicity.