Lung cancer – current treatment

Authors: Skřičková J.;  Kadlec B.;  Venclíček O.;  Merta Z.
Authors‘ workplace: Klinika nemocí plicních a TBC LF MU a FN Brno
Published in: Kardiol Rev Int Med 2019, 21(3): 151-158


Lung cancer is one of the most common cancers worldwide. Approximately 85% of lung cancers are non-small cell lung cancers, while 15% are small cell lung cancers. Histologically, the following subtypes of non-small cell lung cancer are recognised: adenocarcinoma (38.5% of all lung cancers), squamous cell carcinoma (20%), and large cell carcinoma (3%). Over recent years, the incidence of adenocarcinoma has been increasing. The treatment of non-small cell lung cancer is decided according to clinical stage, morphological dia­gnosis, and the performance status of the patient. Early-stage patients are typically indicated for surgery. In some cases, adjuvant therapy is indicated. In locally advanced and metastatic stages, chemotherapy, bio­logical treatment, and, recently, immunotherapy is indicated. Radiotherapy should also be considered for locally advanced disease. In small cell lung cancer, chemotherapy is the standard of care. Recently, immunotherapy has been successfully used in SCLC. Radiotherapy represents an integral part of treatment in both non-small and small cell lung cancer.


lung cancer – non-small cell lung cancer – small cell lung cancer – bio­logical therapy – radiotherapy


1. Dušek L, Malúšková D, Mužík J et al. Epidemiologie zhoubných nádorů plic, průdušnice a průdušek v České republice. Onkologická Revue 2016; 8 (Speciál; Současné trendy v léčbě karcinomu plic): 7–11.

2. Skřičková J, Kolek V a kol. Základy moderní pneumoonkologie. 2. vyd. Praha: Maxdorf 2017.

3. Moulis M. Morfologická dia­gnostika karcinomu plic. In: Skřičková J, Kolek V a kol. Základy moderní pneumoonkologie. 2. vyd. Praha: Maxdorf 2017.

4. Goldstraw P, Chansky K, Crowley J et al. The IASLC Lung Cancer Staging Project: Proposals for revision of the TNM Stage Groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 2016; 11(1): 39–51. doi: 10.1016/ j.jtho.2015.09.009.

5. Lim W, Ridge CA, Nicholson AG et al. The 8th lung cancer TNM classification and clinical staging system: review of the changes and clinical implications. Quant Imaging Med Surg 2018; 8(7): 709–718. doi: 10.21037/ qims.2018.08.02.

6. Brierley JD, Gospodarowicz MK, Wittekind CH. TNM classification of malignant tumours, 8th ed. Wiley-Blackwell Publishing 2017. Česká verze: Praha: Ústav zdravotnických informací a statistiky České Republiky 2017.

7. Zemanová M, Skřičková J, Čoupková H. Zhoubný novotvar bronchu a plíce (C34). In: Modrá kniha České onkologické společnosti. 25. vyd. Brno: Masarykův onkologický ústav 2019.

8. Skřičková J, Venclíček O, Kadlec B et al. Nemalobuněčný karcinom plic. Postgraduální medicína/ Pneumoonkologie 2016; 18 (Suppl 1): 21–27.

9. Sculier JP, Moro-Sibilot D. First-and second-line therapy for advanced nonsmall cell lung cancer. Eur Respir J 2009; 33(4): 915–930. doi: 10.1183/ 09031936.00132008.

10. Pallis AG, Gridelli C, Wedding U et al. Management of elderly patients with NSCLC; updated expert’s opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol 2014; 25(7): 1270–1283. doi: 10.1093/ annonc/ mdu022.

11. Lien K, Georgsdottir S, Sivanathan L et al. Low-dose metronomic chemotherapy: a systematic literature analysis. Eur J Cancer 2013; 49(16): 3387–3395. doi: 10.1016/ j.ejca.2013.06.038.

12. Vašíková A. Principy bio­logické léčby karcinomu plic. In: Skřičková J, Kolek V et al. Základy moderní pneumoonkologie. 2. vyd. Praha: Maxdorf 2017: 162–175.

13. Shepherd FA, Pereira JR, Ciuleanu T et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med 2005; 353(2): 123–132. doi: 10.1056/ NEJMoa050753.

14. Rosell R, Carcereny E, Gervais R et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol 2012; 13(3): 239–246. doi: 10.1016/ S1470-2045(11)70393-X.

15. Mok TS, Wu YL, Thongprasert S et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009; 361(10): 947–957. doi: 10.1056/ NEJMoa0810699.

16. Yang JCH, Schuler MH, Yamamoto N et al. LUX-Lung 3: a randomized, open-label, phase III study of afatinib vs cisplatin/ pemetrexed as 1st-line treatment for patients with advanced adenocarcinoma of the lung harboring EGFR-activating mutations. J Clin Oncol 2012; 30 (Suppl): LBA7500. doi: 10.1200/ jco.2012.30.18_suppl.lba7500.

17. Mok TS, Wu YL, Ahn MJ et al. Osimertinib or platinum-pemetrexed in EGFR T790M-positive lung cancer. N Engl J Med 2017; 376(7): 629–640. doi: 10.1056/ NEJMoa1612674.

18. Ramalingam S, Reungwetwattana T, Chewaskulyong B et al. LBA2_PR: Osimertinib vs standard of care (SoC) EGFR-TKI as first-line therapy in patients (pts) with EGFRm advanced NSCLC: FLAURA. Ann Oncol 2017; 28 (Suppl 5): v605–v649. doi: 10.1093/ annonc/ mdx440c.

19. Crino L, Kim D, Riely GJ et al. Initial phase II results with crizotinib in advanced ALK-positive non-small cell lung cancer (NSCLC): PROFILE 1005. J Clin Oncol 2011; 29 (Suppl 15): 7514. doi: 10.1200/ jco.2011.29.15_suppl.7514.

20. Shaw AT, Kim DW, Nakagawa K et al. Phase III study of crizotinib versus pemetrexed or docetaxel chemotherapy in patients with advanced ALK-positive non-small cell lung cancer (NSCLC)(PROFILE 1007). Ann Oncol 2012; 23 (Suppl 9):ixe21. Available at: https:/ / annonc/ article/ 23/ suppl_9/ ixe1/ 219027.

21. Mok T, Kim DW, Wu YL et al. First-line crizotinib versus pemetrexed–cisplatin or pemetrexed–carboplatin in patients (pts) with advanced ALK-positive non-squamous non-small cell lung cancer (NSCLC): results of a phase III study (PROFILE 1014). J Clin Oncol 2017; 32 (15 Suppl): 8002. doi: 10.1200/ jco.2014.32.15_suppl.8002.

22. Pešek M. Ceritinib-nová naděje pro nemocné s ALK pozitivní přestavbou nemalobuněčných karcinomů plic. Farmakoterapie 2017; 13(5): 35–42.

23. Shaw AT, Kim DW, Mehra R et al. Ceritinib in ALK-rearranged non-small-cell lung cancer. N Engl J Med 2014; 370(13): 1189–1197. doi: 10.1056/ NEJMoa1311107.

24. Scagliotti G, Kim TM, Crinò L et al. Ceritinib vs chemotherapy (CT) in patients (pts) with advanced anaplastic lymphoma kinase (ALK)-rearranged (ALK+) non-small cell lung cancer (NSCLC) previously treated with CT and crizotinib (CRZ): results from the confirmatory phase 3 ASCEND-5 study. 2016. Ann Oncol 2016; 27 (Suppl 6): LBA42_PR. Doi: 10.1093/ annonc/ mdw435.41.

25. Peters S, Camidge DR, Shaw AT et al. Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer. N Engl J Med 2017; 377(9): 829–838.

26. De Castro J, Novello S, Mazieres J et al. 1346P CNS efficacy results from the phase III ALUR study of alectinib vs chemotherapy in previously treated ALK+ NSCLC. Ann Oncol 2017; 28 (Suppl 5): mdx380.048. doi: 10.1093/ annonc/ mdx380.048.

27. Kim DW, Tiseo M, Ahn MJ et al. Brigatinib in patients with crizotinib-refractory anaplastic lymphoma kinase-positive non-small-cell lung cancer: a randomized, multicenter phase II trial. J Clinl Oncol 2017; 35(22): 2490–2498. doi: 10.1200/ JCO.2016.71.5904.

28. Shaw AT, Felip E, Bauer TM et al. Lorlatinib in non-small-cell lung cancer with ALK or ROS1 rearrangement: an international, multicentre, open-label, single-arm first-in-man phase 1trial. Lancet Oncol 2017; 18(12): 1590–1599. doi: 10.1016/ S1470-2045(17)30680-0.

29. Planchard D, Smit EF, Groen HJ et al. Dabrafenib plus trametinib in patients with previo usly untreated BRAFV600E-mutant metastatic non-small-cell lung cancer: an open-label, phase 2 trial. Lancet Oncol 2017; 18(10): 1307–1316. doi: 10.1016/ S1470-2045(17)30679-4.

30. Lopez-Chavez A, Young T, Fages S et al. Bevacizumab maintenance in patients with advanced non–small-cell lung cancer, clinical patterns, and outcomes in the Eastern Cooperative Oncology Group 4599 Study: results of an exploratory analysis. J Thorac Oncol 2012; 7(11): 1707–1712. doi: 10.1097/ JTO.0b013e318265b500.

31. Kadlec B. Úloha bevacizumabu v léčbě nemalobuněčného karcinomu plic. Bevacizumab v onkologické léčbě. Farmakoterapie 2014; 10(2): 193–210.

32. Reck M. Nintedanib (BIBF 1120) plus docetaxel in NSCLC patients progressing after first-line chemotherapy: LUME Lung 1, a randomized, double-blind phase III trial. (Abstract #LBA8011) 2013 ASCO Annual Meeting. J Clin Oncol 2013; 31 (18 suppl): abstr LBA8011. doi: 10.1200/ jco.2013.31.18_suppl.lba8011.

33. Hanna NH, Kaiser R, Sullivan RN et al. LUME-Lung 2: A multicentre, randomized, double-blind, Phase III study of nintedanib plus pemetrexed vs. placebo plus pemetrexed in patients with advanced non-squamous non-small cell lung cancer (NSCLC) after failure of first-line chemotherapy. Chicago: American Society of Clinical Oncology 2013. J Clin Oncol 2013; 31 (15 Suppl): abstr 8034. doi: 10.1200/ jco.2013.31.15_suppl.8034.

34. Vallieres E, Shepherd FA, Crowley J et al. The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forth coming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2009; 4(9): 1049–1059. doi: 10.1097/ JTO.0b013e3181b27799.

35. Almquist D, Mosalpuria K, Ganti AK. Multimodality therapy for limited-stage small-cell lung cancer. J Oncol Pract 2016; 12(2): 111–117. doi: 10.1200/ JOP.2015.009068.

36. Corso CD, Rutter CE, Park HS et al. Role of chemoradiotherapy in elderly patients with limited-stage small-cell lung cancer. J Clin Oncol 2015; 33(36): 4240–4246. doi: 10.1200/ JCO.2015.62.4270.

37. NCCN Clinical Practice Guidelines in Oncology. Small cell lung cancer. NCCN National Comprehensive Cancer Network, version 1. 2008. Available at: https:/ / professionals/ physician_gls/ default.aspx.

38. Niho S, Kubota K, Yoh K et al. Clinical outcome of chemoradiation therapy in patients with limited-disease small cell lung cancer with ipsilateral pleural effusion. J Thorac Oncol 2008; 3(7): 723–727. doi: 10.1097/ JTO.0b013e31817c606a.

39. Hanna N, Bunn PA, Langer C et al. Randomized phase III trial comparing irinotecan/ cisplatin with etoposide/ cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer. J Clin Oncol 2006; 24(13): 2038–2043. doi: 10.1200/ JCO.2005.04.8595.

40. Patel S, Macdonald OK, Suntharalingam M. Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer. Cancer 2009; 115(4): 842–850. doi: 10.1002/ cncr.24105.

41. Kelly RJ, Gulley JL, Giaccone G. Targeting the immune system in non-small cell lung cancer: bridg­ing the gap between promising concept and therapeutic reality. Clin Lung Cancer 2010; 11(4): 228–237. doi: 10.3816/ CLC.2010.n.029.

42. Spigel DR, Reckamp KL, Rizvi NA et al. A phase IIIstudy (CheckMate 017) of nivolumab (NIVO; anti-programmed death-1 (PD-1)) vs docetaxel (DOC) in previously treated advanced or metastatic squamous (SQ) cell non-small cell lung cancer (NSCLC). J Clin Oncol 2015; 33 (15 Suppl): abstr. 8009. doi: 10.1200/ jco.2015.33.15_suppl.8009.

43. Borghaei H, Paz-Ares L, Horn L et al. Nivolumab versus docetaxel in advanced nonsquamous non–small-cell lung cancer. N Engl J Med 2015; 373(17): 1627–1639. doi: 10.1056/ NEJMoa1507643.

44. Pardoll DM. The blockade of immune check­points in cancer immunotherapy. Nat Rev Cancer 2012; 12(4): 252–264. doi: 10.1038/ nrc3239.

45. Herbst RS, Baas P, Kim DW et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet 2016; 387(10027): 1540–1550. doi: 10.1016/ S0140-6736(15)01281-7.

46. Reck M, Rodríguez-Abreu D, Robinson AG et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med 2016; 375(19): 1823–1833. doi: 10.1056/ NEJMoa1606774.

47. Lakomý R, Poprach A. Nežádoucí účinky moderní imunoterapie a jejich řešení v klinické praxi. Klin Onkol 2015; 28 (Suppl 4): 4S103–4S114.

48. Socionski MA, Jotte RM, Cappuzzo F et al. Atezolizumab for first-line treatment of metastatic nonsquamous NSCLC. N Engl J Med 2018; 378(24): 2288–2301. doi: 10.1056/ NEJMoa1716948.

49. Horn L, Mansfield AS, Szczęsna A et al. First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med 2018; 379(23): 2220–2229. doi: 10.1056/ NEJMoa1809064.

50. Antonia SJ, Villegas A, Daniel D et al. Durvalumab after chemoradiotherapy in stage III non-small cell lung cancer. N Engl J Med 2017; 377(20): 1919–1929. doi: 10.1056/ NEJMoa1709937.

51. Antonia SJ, Villegas A, Daniel D et al. Overall survival with durvalumab after chemoradiotherapy in stage III NSCLC. Article and Supplementary Appendix. N Eng J Med 2018; 379(24): 2342–2350. doi: 10.1056/ NEJMoa1809697.

52. Thomas A, Vilimas R, Trindade C et al. Durvalumab in combination with olaparib in patients with relapsed SCLC: results from a phase II study. J Thorac Oncol 2019; 14(8): 1447–1457. doi: 10.1016/ j.jtho.2019.04.026.

Paediatric cardiology Internal medicine Cardiac surgery Cardiology
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account