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Clin Lung Cancer. 2014 Jan;15(1):1-6. doi: 10.1016/j.cllc.2013.10.001. Epub 2013 Oct 12.

Acquired resistance to targeted therapies against oncogene-driven non-small-cell lung cancer: approach to subtyping progressive disease and clinical implications.

Author information

1
Division of Hematology and Oncology, University of California, Davis, Sacramento, CA. Electronic address: david.gandara@ucdmc.ucdavis.edu.
2
Division of Hematology and Oncology, University of California, Davis, Sacramento, CA.
3
Fred Hutchinson Cancer Research Center, Seatlle, WA.

Abstract

In the emerging era of targeted therapy for advanced-stage non-small-cell lung cancer, it is becoming increasingly important to anticipate underlying driver oncogene alterations at the time of initial diagnosis and tumor-tissue acquisition, so that patients can be selected in a timely fashion for first-line tyrosine kinase inhibitor (TKI) therapy if their cancers are found to harbor tyrosine-kinase-activating mutations in the epidermal growth factor receptor gene or gain-of-function rearrangements in the anaplastic lymphoma kinase gene. However, despite the clear benefits of TKI therapy over chemotherapy in these settings, the eventual emergence of acquired resistance and progressive disease (PD) is universal. How to best approach oncogene-driven non-small-cell lung cancer at the time of acquired resistance to initial TKI therapy is an increasingly complex question because of variability in mechanisms of resistance, extent of PD, and inter- and intrapatient tumor heterogeneity. Here we propose an approach to subtyping PD in the setting of acquired resistance as well as subsequent clinical implications.

PMID:
24176733
PMCID:
PMC4586161
DOI:
10.1016/j.cllc.2013.10.001
[Indexed for MEDLINE]
Free PMC Article
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