Oral Agents for the Treatment of Metastatic Non-Small Cell Lung Cancer- Pharmacist
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Lung cancer claims the lives of more people than any other
cancer worldwide. In the US, lung cancer is the third most
commonly diagnosed cancer. In 2018, there were approximately
234,030 new cases diagnosed and over 154,000 lung cancer related
deaths. Lung cancers are histologically (microscopic tissue
structure) defined as small cell lung cancer (SCLC) and non-small
cell lung cancer (NSCLC), accounting for 15% and 85% of cases,
respectively. Adenocarcinoma is the most common subtype of
NSCLC. Because early lung cancer is largely asymptomatic, more
than half of the cases have metastasized at the time of diagnosis.
The treatment landscape for metastatic lung cancer has
changed significantly with the development of targeted oral therapies
and immune checkpoint inhibitor (ICPI) therapy. Unlike chemotherapy,
targeted oral therapy blocks the growth and spread of
cancer cells; not all cells. ICPIs help the immune system distinguish
between cancer and normal cells, allowing the immune
system to attack the cancer cells. Like most new oncology treatments,
ICPIs were initially approved for use later in the sequence
of treatment options – but are now standard of care, first-line
treatments for some patients. This article will not review ICPIs,
but instead focus on the targeted oral therapies available for the
treatment of metastatic NSCLC. More patients are receiving longterm,
targeted oral therapies due to extended progression-free
survival with these medications compared to chemotherapy.