Approved: New Targeted Therapy for Non Small Cell Lung Cancer

80% to 85% of all lung cancers are non–small cell lung cancers. 

There are several types of lung cancer. Each type of NSCLC has different kinds of cancer cells and they grow in different ways. 

The different types are: 

• Squamous cell carcinoma: A type of cancer that forms in the thin, flat cells lining the inside of the lungs-the squamous cells. This type of cancer is also called epidermoid carcinoma.
• Large cell carcinoma: A type of cancer that may begin in several types of large cells.
• Adenocarcinoma: A type of cancer that begins in the cells that line the alveoli and make substances such as mucus.

Treatment for NSCLC based on staging

Occult Cancer

In this case, malignant cells are only seen in sputum cytology. However, no obvious tumors are found with either bronchoscopy or imaging tests. This is early-stage cancer. Cancer specialists mostly repeat bronchoscopy and other tests every few months looking for a tumor. If a tumor is found, the treatment depends on the staging.

Stage 0 Cancer

Stage 0 NSCLC is limited to the lining of the airways. It has not yet invaded deeper into the lung tissue or other areas. So, it is curable by surgery alone most times. 

For certain stage 0 cancers, treatment options such as photodynamic therapy or PDT, laser therapy, or brachytherapy (internal radiation) may be alternatives to surgery. If your cancer is truly stage 0, these treatments should cure you.

Stage I Cancer

For stage I NSCLC,  surgery might be the only treatment option needed. The lobe with the cancerous tumor is either taken out through lobectomy or by taking out a smaller piece of the lung through sleeve resection, segmentectomy, or wedge resection. 

Stage I NSCLC has a higher risk of coming back based on size, location, or other factors, so adjuvant chemotherapy after surgery may lower the risk that cancer will return.

Stage II NSCLC

If people with stage II NSCLC are healthy enough for surgery, usually the cancer is removed by lobectomy or sleeve resection. Sometimes removing the whole lung (pneumonectomy) is needed.

Whether positive margins are found or not, adjuvant chemo is usually recommended after surgery to try to destroy any cancer cells that might have been left behind after surgery. 

If the cancer cells have specific mutations in the EGFR gene, then adjuvant treatment with the targeted drug osimertinib can be an option. Also, if surgery is not an option, radiation therapy can be the main treatment.

Stage III NSCLC and above

For advanced NSCLC, the treatment options often include a combination of surgery, chemotherapy, and radiation therapy. Other favored new and upcoming treatment options include immunotherapy and targeted therapy. But if you want a more definite answer, you can always ask a top lung cancer doctor in Delhi NCR, or India. 

In this blog, we’ll talk about the newly approved targeted therapy.

Newly approved targeted therapy

2-3% of NSCLC have an EGFR exon 20 insertions, contributing to metastasis by stimulating rapid cancer cell growth. This group of mutations on a specific protein causes rapid cell growth. That, in turn, helps cancer spread. EGFR exon 20 insertion mutations are the third most common type of EGFR mutation.

In May 2021, the U.S Food and Drug Administration or USFDA approved Rybrevant (amivantamab-vmjw) as the first treatment for adult patients with NSCLC or non-small cell lung cancer whose tumors have specific types of genetic mutations. These genetic mutations are epidermal growth factor receptor (EGFR) exon 20 insertion mutations.

Not only that, but they also approved the Guardant360 CDx (Guardant Health Inc.) as a companion diagnostic for Rybrevant on the same day. 

Julia Beaver, M.D., chief of medical oncology in the FDA’s Oncology Center of Excellence and acting deputy director of the Office of Oncologic Diseases in the FDA’s Center for Drug Evaluation and Research said, “Advances in precision oncology continue to facilitate drug development, allowing diseases like lung cancer to be subset into biomarker-defined populations appropriate for targeted therapies.” 

According to the cancer specialist, “With today’s approval, for the first time, patients with non-small cell lung cancer with EGFR exon 20 insertion mutations will have a targeted treatment option.”

Rybrevant’s efficacy has been studied in 81 patients with NSCLC and with EGFR exon 20 insertion mutations whose disease had progressed on or after platinum-based chemotherapy. The overall response rate was 40%. 

The approval can benefit many patients today and in the long run. The drug was approved for the Janssen Pharmaceutical Companies of Johnson & Johnson.

In conclusion

Rybrevant’s approval is a step in a new and better direction. It is a sign of new hope for many cancer patients. If you want more fascinating information about Rybrevant or other new approvals and discoveries or if you want to incorporate them into your own treatment routine, you can always consult an expert like Dr. Manish Singhal, a top oncologist in Noida.