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Advances in Molecular Biology of Lung DiseaseAiming for Precision Therapy in NSCLC: Aiming for Precision Therapy in Non-small Cell Lung Cancer

Claire Rooney, MBChB; Tariq Sethi, MD, PhD
Author and Funding Information

From the Division of Asthma, Allergy and Lung Biology (Drs Rooney and Sethi), King’s College London; and Department of Respiratory Medicine (Dr Sethi), King’s Health Partners, London, England.

CORRESPONDENCE TO: Tariq Sethi, MD, PhD, Division of Asthma, Allergy and Lung Biology, King’s College London, Guy’s Hospital, Great Maze Pond, London, SE1 9RT, England; e-mail: tariq.sethi@kcl.ac.uk


FUNDING/SUPPORT: The research was supported by the National Institute for Health Research Biomedical Research Centre based at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):1063-1072. doi:10.1378/chest.14-2663
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Lung cancer is the principal cause of cancer-related mortality in the developed world, accounting for almost one-quarter of all cancer deaths. Traditional treatment algorithms have largely relied on histologic subtype and have comprised pragmatic chemotherapy regimens with limited efficacy. However, because our understanding of the molecular basis of disease in non-small cell lung cancer (NSCLC) has improved exponentially, it has become apparent that NSCLC can be radically subdivided, or molecularly characterized, based on recurrent driver mutations occurring in specific oncogenes. We know that the presence of such mutations leads to constitutive activation of aberrant signaling proteins that initiate, progress, and sustain tumorigenesis. This persistence of the malignant phenotype is referred to as “oncogene addiction.” On this basis, a paradigm shift in treatment approach has occurred. Rational, targeted therapies have been developed, the first being tyrosine kinase inhibitors (TKIs), which entered the clinical arena > 10 years ago. These were tremendously successful, significantly affecting the natural history of NSCLC and improving patient outcomes. However, the benefits of these drugs are somewhat limited by the emergence of adaptive resistance mechanisms, and efforts to tackle this phenomenon are ongoing. A better understanding of all types of oncogene-driven NSCLC and the occurrence of TKI resistance will help us to further develop second- and third-generation small molecule inhibitors and will expand our range of precision therapies for this disease.

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