Non–Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment
Lung cancer remains the leading cause of cancer deaths in the United States. In the past decade, significant advances have been made in the science of non–small cell lung cancer (NSCLC). Screening has been introduced with the goal of early detection. The National Lung Screening Trial found a lung ca...
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description | Lung cancer remains the leading cause of cancer deaths in the United States. In the past decade, significant advances have been made in the science of non–small cell lung cancer (NSCLC). Screening has been introduced with the goal of early detection. The National Lung Screening Trial found a lung cancer mortality benefit of 20% and a 6.7% decrease in all-cause mortality with the use of low-dose chest computed tomography in high-risk individuals. The treatment of lung cancer has also evolved with the introduction of several lines of tyrosine kinase inhibitors in patients with EGFR, ALK, ROS1, and NTRK mutations. Similarly, immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Furthermore, the results of new trials continue to help us understand the role of these novel agents and which patients are more likely to benefit; ICIs are now part of the first-line NSCLC treatment armamentarium as monotherapy, combined with chemotherapy, or after definite chemoradiotherapy in patients with stage III unresectable NSCLC. Expression of programmed cell death protein-ligand 1 in malignant cells has been studied as a potential biomarker for response to ICIs. However, important drawbacks exist that limit its discriminatory potential. Identification of accurate predictive biomarkers beyond programmed cell death protein-ligand 1 expression remains essential to select the most appropriate candidates for ICI therapy. Many questions remain unanswered regarding the proper sequence and combinations of these new agents; however, the field is moving rapidly, and the overall direction is optimistic. |
doi_str_mv | 10.1016/j.mayocp.2019.01.013 |
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In the past decade, significant advances have been made in the science of non–small cell lung cancer (NSCLC). Screening has been introduced with the goal of early detection. The National Lung Screening Trial found a lung cancer mortality benefit of 20% and a 6.7% decrease in all-cause mortality with the use of low-dose chest computed tomography in high-risk individuals. The treatment of lung cancer has also evolved with the introduction of several lines of tyrosine kinase inhibitors in patients with EGFR, ALK, ROS1, and NTRK mutations. Similarly, immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Furthermore, the results of new trials continue to help us understand the role of these novel agents and which patients are more likely to benefit; ICIs are now part of the first-line NSCLC treatment armamentarium as monotherapy, combined with chemotherapy, or after definite chemoradiotherapy in patients with stage III unresectable NSCLC. Expression of programmed cell death protein-ligand 1 in malignant cells has been studied as a potential biomarker for response to ICIs. However, important drawbacks exist that limit its discriminatory potential. Identification of accurate predictive biomarkers beyond programmed cell death protein-ligand 1 expression remains essential to select the most appropriate candidates for ICI therapy. Many questions remain unanswered regarding the proper sequence and combinations of these new agents; however, the field is moving rapidly, and the overall direction is optimistic.</description><identifier>ISSN: 0025-6196</identifier><identifier>EISSN: 1942-5546</identifier><identifier>DOI: 10.1016/j.mayocp.2019.01.013</identifier><identifier>PMID: 31378236</identifier><language>eng</language><publisher>England: Elsevier Inc</publisher><subject>Cancer treatment ; Carcinoma, Non-Small-Cell Lung - diagnosis ; Carcinoma, Non-Small-Cell Lung - epidemiology ; Carcinoma, Non-Small-Cell Lung - prevention & control ; Carcinoma, Non-Small-Cell Lung - therapy ; CAT scans ; Chemoradiotherapy - methods ; Chemotherapy, Adjuvant ; Diagnosis ; Diagnostic imaging ; Disease-Free Survival ; Durvalumab ; Early Detection of Cancer - methods ; Education, Medical, Continuing ; Epidemiology ; Female ; Humans ; Immunotherapy - methods ; Ionizing radiation ; Lung cancer ; Lung Neoplasms - diagnosis ; Lung Neoplasms - epidemiology ; Lung Neoplasms - prevention & control ; Lung Neoplasms - therapy ; Male ; Molecular Targeted Therapy - methods ; Non-small cell lung cancer ; Phenols (Class of compounds) ; Pneumonectomy - methods ; Prognosis ; Respiratory system agents ; Risk Assessment ; Small cell lung cancer ; Survival Analysis ; Tomography ; Tyrosine ; United States</subject><ispartof>Mayo Clinic proceedings, 2019-08, Vol.94 (8), p.1623-1640</ispartof><rights>2019 Mayo Foundation for Medical Education and Research</rights><rights>Copyright © 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.</rights><rights>COPYRIGHT 2019 Frontline Medical Communications Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c556t-385b4e6675a323eba8e5f9cc9731a853b4d550165b5e362dcb2012db88776e4b3</citedby><cites>FETCH-LOGICAL-c556t-385b4e6675a323eba8e5f9cc9731a853b4d550165b5e362dcb2012db88776e4b3</cites><orcidid>0000-0002-9962-4635 ; 0000-0001-5051-1755</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925,64387</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31378236$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Duma, Narjust</creatorcontrib><creatorcontrib>Santana-Davila, Rafael</creatorcontrib><creatorcontrib>Molina, Julian R.</creatorcontrib><title>Non–Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment</title><title>Mayo Clinic proceedings</title><addtitle>Mayo Clin Proc</addtitle><description>Lung cancer remains the leading cause of cancer deaths in the United States. In the past decade, significant advances have been made in the science of non–small cell lung cancer (NSCLC). Screening has been introduced with the goal of early detection. The National Lung Screening Trial found a lung cancer mortality benefit of 20% and a 6.7% decrease in all-cause mortality with the use of low-dose chest computed tomography in high-risk individuals. The treatment of lung cancer has also evolved with the introduction of several lines of tyrosine kinase inhibitors in patients with EGFR, ALK, ROS1, and NTRK mutations. Similarly, immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Furthermore, the results of new trials continue to help us understand the role of these novel agents and which patients are more likely to benefit; ICIs are now part of the first-line NSCLC treatment armamentarium as monotherapy, combined with chemotherapy, or after definite chemoradiotherapy in patients with stage III unresectable NSCLC. Expression of programmed cell death protein-ligand 1 in malignant cells has been studied as a potential biomarker for response to ICIs. However, important drawbacks exist that limit its discriminatory potential. Identification of accurate predictive biomarkers beyond programmed cell death protein-ligand 1 expression remains essential to select the most appropriate candidates for ICI therapy. Many questions remain unanswered regarding the proper sequence and combinations of these new agents; however, the field is moving rapidly, and the overall direction is optimistic.</description><subject>Cancer treatment</subject><subject>Carcinoma, Non-Small-Cell Lung - diagnosis</subject><subject>Carcinoma, Non-Small-Cell Lung - epidemiology</subject><subject>Carcinoma, Non-Small-Cell Lung - prevention & control</subject><subject>Carcinoma, Non-Small-Cell Lung - therapy</subject><subject>CAT scans</subject><subject>Chemoradiotherapy - methods</subject><subject>Chemotherapy, Adjuvant</subject><subject>Diagnosis</subject><subject>Diagnostic imaging</subject><subject>Disease-Free Survival</subject><subject>Durvalumab</subject><subject>Early Detection of Cancer - methods</subject><subject>Education, Medical, Continuing</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Immunotherapy - methods</subject><subject>Ionizing radiation</subject><subject>Lung cancer</subject><subject>Lung Neoplasms - diagnosis</subject><subject>Lung Neoplasms - epidemiology</subject><subject>Lung Neoplasms - prevention & control</subject><subject>Lung Neoplasms - therapy</subject><subject>Male</subject><subject>Molecular Targeted Therapy - methods</subject><subject>Non-small cell lung cancer</subject><subject>Phenols (Class of compounds)</subject><subject>Pneumonectomy - methods</subject><subject>Prognosis</subject><subject>Respiratory system agents</subject><subject>Risk Assessment</subject><subject>Small cell lung cancer</subject><subject>Survival Analysis</subject><subject>Tomography</subject><subject>Tyrosine</subject><subject>United States</subject><issn>0025-6196</issn><issn>1942-5546</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtO4zAUQC3EiJbCHyCUFWLRdPyInYQFEiqPGakaFsDacpzb4Cqxi52M1B3_MH84X4JRgCXS1b2bc18HoROCFwQT8XOz6NTO6e2CYlIuMInB9tCUlBlNOc_EPppiTHkqSCkm6DCEDcY4L8vsAE0YYXlBmZii-z_O_n_999Cptk2WENNqsE2yVFaDv0hutqaGzrjWNbt58qA9gDW2mSfXRjXWBRPmibJ18uhB9R3Y_gj9WKs2wPFHnaGn25vH5a90dX_3e3m1SjXnok9ZwasMhMi5YpRBpQrg61LrMmdEFZxVWc15_JJXHJigta7il7SuiiLPBWQVm6Hzce7Wu5cBQi87E3S8X1lwQ5CUioLnmShJRM9GtFEtyGdQbf8cXDv0xtkgr0TUwgTJcQSzEdTeheBhLbfedMrvJMHy3bncyNG5fHcuMYnBYtvpxylD1UH91fQpOQKXIwBRyF8DXgZtIAqujQfdy9qZ7ze8AYn8kw8</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Duma, Narjust</creator><creator>Santana-Davila, Rafael</creator><creator>Molina, Julian R.</creator><general>Elsevier Inc</general><general>Frontline Medical Communications Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9962-4635</orcidid><orcidid>https://orcid.org/0000-0001-5051-1755</orcidid></search><sort><creationdate>201908</creationdate><title>Non–Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment</title><author>Duma, Narjust ; Santana-Davila, Rafael ; Molina, Julian R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c556t-385b4e6675a323eba8e5f9cc9731a853b4d550165b5e362dcb2012db88776e4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Cancer treatment</topic><topic>Carcinoma, Non-Small-Cell Lung - diagnosis</topic><topic>Carcinoma, Non-Small-Cell Lung - epidemiology</topic><topic>Carcinoma, Non-Small-Cell Lung - prevention & control</topic><topic>Carcinoma, Non-Small-Cell Lung - therapy</topic><topic>CAT scans</topic><topic>Chemoradiotherapy - methods</topic><topic>Chemotherapy, Adjuvant</topic><topic>Diagnosis</topic><topic>Diagnostic imaging</topic><topic>Disease-Free Survival</topic><topic>Durvalumab</topic><topic>Early Detection of Cancer - methods</topic><topic>Education, Medical, Continuing</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Immunotherapy - methods</topic><topic>Ionizing radiation</topic><topic>Lung cancer</topic><topic>Lung Neoplasms - diagnosis</topic><topic>Lung Neoplasms - epidemiology</topic><topic>Lung Neoplasms - prevention & control</topic><topic>Lung Neoplasms - therapy</topic><topic>Male</topic><topic>Molecular Targeted Therapy - methods</topic><topic>Non-small cell lung cancer</topic><topic>Phenols (Class of compounds)</topic><topic>Pneumonectomy - methods</topic><topic>Prognosis</topic><topic>Respiratory system agents</topic><topic>Risk Assessment</topic><topic>Small cell lung cancer</topic><topic>Survival Analysis</topic><topic>Tomography</topic><topic>Tyrosine</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Duma, Narjust</creatorcontrib><creatorcontrib>Santana-Davila, Rafael</creatorcontrib><creatorcontrib>Molina, Julian R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Mayo Clinic proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Duma, Narjust</au><au>Santana-Davila, Rafael</au><au>Molina, Julian R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non–Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment</atitle><jtitle>Mayo Clinic proceedings</jtitle><addtitle>Mayo Clin Proc</addtitle><date>2019-08</date><risdate>2019</risdate><volume>94</volume><issue>8</issue><spage>1623</spage><epage>1640</epage><pages>1623-1640</pages><issn>0025-6196</issn><eissn>1942-5546</eissn><abstract>Lung cancer remains the leading cause of cancer deaths in the United States. In the past decade, significant advances have been made in the science of non–small cell lung cancer (NSCLC). Screening has been introduced with the goal of early detection. The National Lung Screening Trial found a lung cancer mortality benefit of 20% and a 6.7% decrease in all-cause mortality with the use of low-dose chest computed tomography in high-risk individuals. The treatment of lung cancer has also evolved with the introduction of several lines of tyrosine kinase inhibitors in patients with EGFR, ALK, ROS1, and NTRK mutations. Similarly, immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Furthermore, the results of new trials continue to help us understand the role of these novel agents and which patients are more likely to benefit; ICIs are now part of the first-line NSCLC treatment armamentarium as monotherapy, combined with chemotherapy, or after definite chemoradiotherapy in patients with stage III unresectable NSCLC. Expression of programmed cell death protein-ligand 1 in malignant cells has been studied as a potential biomarker for response to ICIs. However, important drawbacks exist that limit its discriminatory potential. Identification of accurate predictive biomarkers beyond programmed cell death protein-ligand 1 expression remains essential to select the most appropriate candidates for ICI therapy. Many questions remain unanswered regarding the proper sequence and combinations of these new agents; however, the field is moving rapidly, and the overall direction is optimistic.</abstract><cop>England</cop><pub>Elsevier Inc</pub><pmid>31378236</pmid><doi>10.1016/j.mayocp.2019.01.013</doi><tpages>18</tpages><orcidid>https://orcid.org/0000-0002-9962-4635</orcidid><orcidid>https://orcid.org/0000-0001-5051-1755</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Cancer treatment Carcinoma, Non-Small-Cell Lung - diagnosis Carcinoma, Non-Small-Cell Lung - epidemiology Carcinoma, Non-Small-Cell Lung - prevention & control Carcinoma, Non-Small-Cell Lung - therapy CAT scans Chemoradiotherapy - methods Chemotherapy, Adjuvant Diagnosis Diagnostic imaging Disease-Free Survival Durvalumab Early Detection of Cancer - methods Education, Medical, Continuing Epidemiology Female Humans Immunotherapy - methods Ionizing radiation Lung cancer Lung Neoplasms - diagnosis Lung Neoplasms - epidemiology Lung Neoplasms - prevention & control Lung Neoplasms - therapy Male Molecular Targeted Therapy - methods Non-small cell lung cancer Phenols (Class of compounds) Pneumonectomy - methods Prognosis Respiratory system agents Risk Assessment Small cell lung cancer Survival Analysis Tomography Tyrosine United States |
title | Non–Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment |
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