Oral Agents for the Treatment of Metastatic Non-Small Cell Lung Cancer- Pharmacist

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.