The recognition that non–small cell lung cancer (NSCLC) is not a single disease entity,
but rather a collection of distinct molecularly driven neoplasms, has permanently
shifted the therapeutic landscape of NSCLC to a personalized approach. This personalization
of NSCLC therapy is typified by the dramatic response rates seen in EGFR mutant NSCLC when treated with targeted tyrosine kinase inhibitor therapy and in
ALK translocation–driven NSCLC when treated with ALK inhibitors. Targeted therapeutic
approaches in NSCLC necessitate consideration of more invasive biopsy techniques aimed
at providing sufficient tissue for both histological determination and molecular profiling
in all patients with stage IV disease both at the time of diagnosis and at the time
of disease progression. Comprehensive genotyping efforts have identified oncogenic
drivers in 62% lung adenocarcinomas and an increasing proportion of squamous cell
carcinomas of the lung. The identification of these oncogenic drivers and the triage
of patients to clinical trials evaluating novel targeted therapeutic approaches will
increasingly mold a landscape of personalized lung cancer therapy where each genotype
has an associated targeted therapy. This review outlines the state of personalized
lung cancer therapy as it pertains to individual NSCLC genotypes.
Keywords
non–small cell lung cancer - personalized therapy - oncogenic driver mutations
