National Comprehensive Cancer Network

About NCCN

NCCN Trends™ Highlights: Targeted Therapy in Non-Small Cell Lung Cancer

By Sherry L. Ulrich, MBA, Market Insights Specialist

The National Cancer Institute at the National Institutes of Health estimates that, in 2014, approximately 224,000 new cases of lung cancer will be diagnosed in the United States.1,2 The majority of lung cancer cases diagnosed in the United States are classified as Non-Small Cell Lung Cancer (NSCLC), a classification of lung cancer with low survival rates.3 As with other cancer types, targeted therapies for the treatment of NSCLC, such as anaplastic lymphoma kinase (ALK) and epidermal growth factor receptor (EGFR) inhibitors are in continuous development and research indicates that these targeted therapies improve progression-free survival.2

In November 2013, the National Comprehensive Cancer Network® (NCCN®) conducted an NCCN Trends™ survey about testing for mutations and the use of targeted treatments of NSCLC.  Eighty-two percent of respondents noted that they test for mutations prior to front line therapy when treating patients with NSCLC.

Clinicians were also asked how they treat patients with driver mutations (EGFR, ALK) who developed resistance to first-line targeted therapy.  The top three treatment regimens for EGFR mutation-positive patients were erlotinib, pemetrexed, and docetaxel, respectively.  For patients testing positive for ALK mutation, the most commonly prescribed regimens were crizotinib and clinical trial, respectively, followed by docetaxel and pemetrexed, both of which ranked equally. 

According to Sequist LV, et al, with evidence of tumor evolution and resistance to therapy(ies), clinicians should consider  molecular/diagnostic testing at each stage of disease progression and/or at the time of clinical decisions, particularly with advanced disease.At the time of this survey, less than 30% of respondents indicated that they generally conduct a repeat biopsy at disease progression.

In addition to EGFR and ALK, mesenchymal-epithelial transition (MET) is another biomarker which has a role in tumor response. When expressed normally, MET plays a positive role in NSCLC and other tumor types; however, abnormal expression, such as acquired resistance to TK inhibitors, has been noted to contribute to poor outcomes. 3,5 Studies are currently being conducted to inhibit MET expression, some of which are using immunohistochemistry (IHC) testing for MET overexpression as part of the patient selection process.3 When this survey was conducted, 67% of participants responded they were “Not at all familiar” or “Slightly familiar” with IHC testing for MET amplification.

In summary, lung cancer is one of the most frequently diagnosed types of cancer in the United States with approximately 224,000 new cases and 159,000 deaths estimated to occur in 2014, which is by far the most deaths across any cancer type.While some classifications of lung cancer remain difficult to treat, researchers continue to investigate possible targets and compounds to advance this area of unmet medical need.  

Additional Resources:

Biomarker Resources

Please visit NCCN.org/policy to download a white paper published in JNCCN – Journal of the National Comprehensive Cancer Network.  This paper summarizes in detail the NCCN Policy Summit: Designing Clinical Trials in the Era of Multiple Biomarkers and Targeted Therapies.

Based directly on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), the NCCN Biomarkers Compendium® contains information designed to support decision-making around the use of biomarker testing in patients with cancer. Visit NCCN.org to learn more about the NCCN Biomarkers Compendium®.

 

Educational Resources

NCCN will be co-sponsoring complimentary CME Summits on Non-Small Cell Lung Cancer.  Through case-based discussions and interactive simulations, this interdisciplinary summit will seek to address specific unmet needs and clinical gaps in the care of patients with locally advanced and metastatic non-small cell lung cancer (NSCLC). The goal is to advance the knowledge, competence, and performance of a team of interdisciplinary specialists who are currently responsible for appropriate staging, mediastinal lymph node assessment, tissue acquisition, biomarker analysis and immunotherapy in patients with NSCLC.  For additional information and to register, please visit:

http://www.nccn.org/professionals/meetings/regionals/engaging_interdisciplinary_team.aspx

NCCN Trends Surveys & Data

NCCN Trends is a survey-based analytics tool from NCCN that focuses on how clinicians in the United States and abroad deliver cancer care. NCCN Trends Surveys pose questions regarding topics including, but not limited to, patterns of care and awareness and utilization of various treatment modalities, as well as key topics impacting oncology stakeholders, such as how changes in the health care environment impact them and their patients.

Data is gathered through brief electronic surveys to more than 154,000 health care providers who access NCCN.org on a frequent basis and express interest in responding to NCCN Trends Surveys. These clinicians consist of practicing physicians in diverse practice settings, including academic/research cancer centers, community hospitals, and private practices. Survey participants also represent pharmacists, nurses, and other oncology stakeholders. In 2013, NCCN conducted 12 NCCN Trends Surveys, averaging more than 1,100 clinician respondents per survey.

NCCN TrendsSurveys and Data are independent of any NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) or other NCCN clinical recommendations.


1. National Cancer Institute at the National Institutes of Health. http://www.cancer.gov/cancertopics/types/commoncancers.  Accessed November 11,  2014

2. National Comprehensive Cancer Network®, NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®); Non-Small Cell Lung Cancer, Version 1.2015. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#nscl.

3. Robinson KW, Sandler AB. The Role of MET Receptor Tyrosine Kinase in Non-Small Cell Lung Cancer and Clinical Development of Targeted Anti-MET Agents. The Oncologist. 2013;18:115-122.

4. Sequist LV, Waltman BA, Dias-Santagata D, Digumarthy S, et al. Genotypic and Histological Evolution of Lung Cancers Acquiring Resistance to EGFR Inhibitors. Sci Transl Med. 2011:3(75) 75ra26. doi: 10.1126/scitranslmed.3002003.

5. Agwa ES, Ma PC. Targeting the MET receptor tyrosine kinase in non-small cell lung cancer: emerging role of tivantinib. Cancer Management and Research. 2014:6 397-404.