In 2020, the U.S. Food and Drug Administration (FDA) approved three new drugs to treat lung cancer, along with expanded use of eight previously approved therapeutics.
Non-small cell lung cancer (NSCLC) accounts for most cases (80% to 85%) of lung cancer. There are a number of different mutations that can accelerate the spread (metastases) of lung cancer. Two new molecularly targeted therapeutic drugs have been approved to treat specific mutations:
- Capmatinib (Tabrecta) was approved in May 2020 to treat adult patients with metastatic NSCLC whose tumors have a mutation that leads to MET exon 14 skipping
- Pralsetinib (Gavreto; previously called BLU-667) was approved in September 2020 to treat patients with metastatic RET fusion-positive NSCLC
Small cell lung cancer (SCLC) is less common (10% to 15%) than NSCLC, has a worse prognosis, and has fewer treatment options.
- Lurbinectedin (Zepzelca) was approved in June 2020 for patients with metastatic SCLC whose cancer progressed on or after platinum-based chemotherapy
- The combination of lurbinectedin with immune checkpoint inhibitors nivolumab (Opdivo) and ipilimumab (Yervoy) is being investigated in a clinical trial among patients with relapsed and/or recurrent SCLC
The FDA also approved the expanded use of eight previously approved therapeutics:
- PD-L1 inhibitor durvalumab (Imfinzi) in combination with etoposide and either carboplatin or cisplatin was approved as first-line treatment of patients with extensive-stage SCLC
- Nivolumab and ipilimumab were approved as first-line treatment for patients with metastatic NSCLC with PD-L1 tumor expression of at least 1 percent, with no epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) genomic tumor aberrations
- PD-L1 inhibitor atezolizumab (Tecentriq) was approved for first-line treatment of patients with metastatic NSCLC whose tumors have high PD-L1 expression and with no EGFR or ALK genomic tumor aberrations
- Nivolumab plus ipilimumab and two cycles of platinum-doublet chemotherapy were approved as first-line treatment for patients with metastatic or recurrent NSCLC and with no EGFR or ALK genomic tumor aberrations
- PD-1 inhibitor pembrolizumab (Keytruda) was approved to treat patients with unresectable or metastatic tumor mutational burden-high (TMB-high) solid tumors, whose cancer has progressed following prior treatment and who have no satisfactory alternative treatment options
- RET inhibitor selpercatinib (Retevmo) was approved for adult patients with metastatic RET fusion-positive NSCLC
- Dual ALK/EGFR inhibitor brigatinib (Alunbrig) was approved for patients with ALK-positive metastatic NSCLC
- VEGFR-2 inhibitor ramucirumab (Cyramza) in combination with the EGFR inhibitor erlotinib (Tarceva) was approved for first-line treatment of metastatic NSCLC with EGFR exon 19 deletions or exon 21 (L858R) mutations
What Are Symptoms of Lung Cancer?
In the early stages of lung cancer, a person may not notice any symptoms. The first signs and symptoms, if they occur, may include:
- Persistent or worsening cough
- Coughing up blood or rust-colored sputum
- Shortness of breath
- Breathing problems
- Chest pain that may be worse with deep breathing, coughing, or laughing
- Hoarseness
- Loss of appetite
- Unexplained weight loss
- Fatigue/tiredness
- Weakness
- Wheezing
- Recurrent respiratory infections (bronchitis and pneumonia)
What Causes Lung Cancer?
The main cause of all types of lung cancer is smoking. Smoking accounts for 80% of all lung cancer deaths, and also contributes to many deaths from secondhand smoke exposure. Smokers exposed to radon and asbestos are at higher risk.
The most common causes of lung cancer in non-smokers include:
- Air pollution
- Secondhand smoke
- Exposure to radon
- Workplace exposure to asbestos, diesel exhaust, or other chemicals
- Genetic changes
How Is Lung Cancer Diagnosed?
Because lung cancer symptoms usually do not appear until the cancer is advanced, the American Cancer Society has lung cancer screening guidelines for people who may be at a higher risk of getting lung cancer, such as smokers.
The American Cancer Society recommends people who are 55 to 74 years old, are in fairly good health, are current smokers or who have quit in the past 15 years, and have smoked a certain number of cigarettes per day should receive regular lung cancer screenings. A test called a low-dose CAT scan or CT scan (LDCT) is typically used.
If lung cancer is suspected, imaging tests may be used to diagnose it, such as:
- Chest X-ray
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET) scan
- Bone scan
Lab tests used to diagnose lung cancer include:
- Sputum cytology
- Thoracentesis
- Tissue biopsy
- Bronchoscopy masses
- Endobronchial ultrasound
- Endoscopic esophageal ultrasound
- Mediastinoscopy and mediastinotomy
- Thoracoscopy
- Lung function tests
- Molecular tests for gene changes
- Tests for certain proteins on tumor cells
- Blood tests
- Complete blood count (CBC)
- Blood chemistry
What Is the Treatment for Lung Cancer?
The type of lung cancer treatment your doctor will recommend depends on the stage of cancer. Lung cancer treatment options may include:
- Surgery
- Removal of the tumor (stage 0)
- Removal of the lobe of the lung that has the tumor (lobectomy) or removal of a smaller piece of the lung (sleeve resection, segmentectomy, or wedge resection) (Stage 1)
- Lobectomy or sleeve resection or removal of the entire lung (pneumonectomy) (Stage 2 and later stages)
- Photodynamic therapy (PDT)
- Laser therapy
- Adjuvant chemotherapy
- Radiation therapy
- Radiofrequency ablation (RFA)
- Lymph node removal
- Chemotherapy
- Targeted therapy
- Immunotherapy with pembrolizumab (Keytruda) or durvalumab (Imfinzi)
- Participation in clinical trials
Stage 4 lung cancers are widespread and very hard to treat and cure. Any of the above treatments may be used to help patients live longer, but they are unlikely to cure the disease at this stage.
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