Dr. Pennell on the Evolution of Targeted Treatment in NSCLC

Nathan Pennell, MD, PhD, an associate professor in the Department of Medicine and director of the Lung Cancer Medical Oncology Program at the Taussig Cancer Institute of Cleveland Clinic, discusses the evolution of targeted therapies in the field of non–small cell lung cancer (NSCLC).

Ten to 15 years ago, NSCLC was still being treated as a single disease where every patient received chemotherapy, says Pennell. Then, with the discovery of activating mutations in the abnormal growth factor receptor, the era of targeted therapies and molecular testing for lung cancer began.

Over the past few years, this movement has accerlated. Now, several different molecular alterations within nonsquamous NSCLC or adenocarcinoma of the lung are being tested for, says Pennell. In May 2020, 2 new drugs were approved for patients with MET exon 14 skipping–mutated NSCLC and RET fusion–positive lung cancer.

The guidelines issued by the College of American Pathologists still recommend testing for EGFR, ALK, and ROS1 alterations, even though since 2018 there drugs have also been approved for patients with BRAF V600E–mutant disease. Then, with the addition of RET fusions and MET aberrations, there is a wide range of available FDA-approved options for different patient populations. NTRK fusions have also emerged; these aberrations are very rare but still have effective treatment options available if they are identified, explains Pennell. 

With all of these changes, patients must be educated to speak with their providers about available options. Oncologists must also stay educated on emerging data, according to Pennell. If genetic alterations are not identified, patients run the risk of receiving suboptimal treatment for their disease, concludes Pennell.