Precision oncology, which tailors treatment based on individual tumor characteristics, has emerged as a critical paradigm in lung cancer management, improving survival rates and patient outcomes.
Precision Oncology in Lung Cancer: Modern Approach For Cancer Treatment
Lung cancer remains one of the most common and deadly malignancies worldwide, with non-small cell lung cancer (NSCLC) comprising approximately 85% of all cases. Traditionally, treatment approaches relied on histological classification and chemotherapy; however, advances in molecular profiling have revolutionized the therapeutic landscape. Precision oncology, which tailors treatment based on individual tumor characteristics, has emerged as a critical paradigm in lung cancer management, improving survival rates and patient outcomes.
The Role of Molecular Testing
Molecular testing is the cornerstone of precision oncology. Next-generation sequencing (NGS) and other biomarker-driven tests help identify actionable mutations, guiding targeted therapy selection. Key genetic alterations in NSCLC include EGFR mutations, ALK and ROS1 rearrangements, BRAF mutations, MET exon 14 skipping mutations, and NTRK fusions. Identifying these mutations allows clinicians to administer therapies that specifically inhibit oncogenic drivers, leading to better responses and fewer side effects compared to conventional chemotherapy.
Targeted Therapy in Lung Cancer
Targeted therapies have dramatically transformed NSCLC treatment. For EGFR-mutant lung cancer, first-line options include osimertinib, which has demonstrated superior progression-free survival (PFS) compared to older EGFR inhibitors. ALK-positive NSCLC patients benefit from tyrosine kinase inhibitors (TKIs) such as alectinib, brigatinib, and lorlatinib, which have shown significant efficacy and improved tolerability.
Other notable targeted therapies include crizotinib and entrectinib for ROS1 rearrangements, dabrafenib plus trametinib for BRAF V600E mutations, and capmatinib or tepotinib for MET exon 14 skipping alterations. NTRK fusion-positive NSCLC patients can be treated with larotrectinib or entrectinib, demonstrating the success of precision medicine in identifying and treating rare oncogenic drivers.
Immunotherapy and Biomarker-Based Selection
Immunotherapy has revolutionized lung cancer treatment, particularly with immune checkpoint inhibitors (ICIs) targeting PD-1/PD-L1. The effectiveness of these agents depends on PD-L1 expression levels and tumor mutational burden (TMB), highlighting the importance of biomarker-based patient selection. Pembrolizumab, nivolumab, atezolizumab, and durvalumab are key ICIs that have improved survival in advanced NSCLC, either as monotherapy or in combination with chemotherapy.
Challenges in Precision Oncology
Despite significant progress, challenges remain in implementing precision oncology broadly. Access to molecular testing varies across regions, and the high cost of targeted therapies can limit patient access. Additionally, tumors can develop resistance to targeted agents, necessitating continuous research for novel treatment strategies. The emergence of liquid biopsy, which detects circulating tumor DNA (ctDNA), offers a non-invasive alternative to tissue biopsy, enabling real-time monitoring of tumor evolution and resistance mechanisms.
Future Perspectives
The future of precision oncology in lung cancer lies in combination strategies, novel biomarker discovery, and the integration of artificial intelligence (AI) in treatment decision-making. Ongoing research into antibody-drug conjugates, bispecific antibodies, and next-generation immunotherapies holds promise for overcoming resistance and improving outcomes.
As the field advances, multidisciplinary collaboration between oncologists, molecular pathologists, and bioinformaticians will be essential to optimize precision medicine approaches. Personalized treatment strategies will continue to evolve, offering hope for improved survival and quality of life in lung cancer patients.
Precision oncology has transformed the treatment landscape of lung cancer by leveraging molecular insights to guide targeted and immunotherapy-based approaches. While challenges such as accessibility and resistance persist, ongoing research and technological advancements are paving the way for more effective and personalized treatment strategies. As precision medicine continues to evolve, it holds the potential to significantly improve outcomes for lung cancer patients worldwide.
By:
Dr Mohit Agarwal, Senior Director Medical Oncology, Fortis Hospital, Shalimar Bagh
This article is a part of Lung Connect India Foundation's initiative 'Lung Cancer Awareness - United In Our Goals', focusing on lung cancer prevention, diagnosis, and treatment.
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