Anti-angiogenesis Therapy in Lung Cancer: a Practical Approach

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Hong Kong J Radiol 2013;16(Suppl):S55-9

In advanced pulmonary carcinoma, determination of epidermal growth factor receptor (EGFR) mutation status, histology, and anaplastic lymphoma kinase (ALK) mutation status can be highly instructive for guiding the course of treatment. EGFR mutation status is a strong predictor of response to EGFR tyrosine kinase inhibitor therapy; non-squamous cell carcinoma predicts response to pemetrexed; and targeted therapy now exists for non–small-cell lung cancer that is positive for the ALK gene mutation. A patient case of advanced non–small-cell lung cancer is presented to provide a practical context for discussing management. The patient is a 55-year-old female never-smoker who presented with a dry, persistent cough, right scapular and persistent upper- / mid-thoracic back pain, and significant, gradual weight loss. She required urgent surgery to relieve spinal cord compression. The diagnosis of primary adenocarcinoma of the lung, positive for CK7 and TTF-1, and negative for CK20, was made following physical examination, imaging, and pathological investigations. The patient was initially treated with standard platinum-based chemotherapy, to which bevacizumab was added following disease progression — a strategy that met with good response and tolerability. Upon disease progression and determination of ALK-positive non–small-cell lung cancer, targeted therapy with crizotinib was initiated, which showed good partial response until the last follow-up in July 2013. The evidence-based rationale for the treatment approach adopted for this patient is described.