Targeted therapy for lung cancer: present and future

Recent advances in methods of genomic profiling have accelerated our understanding of the biology of oncologic diseases. Accumulating evidence suggests that both histology and molecular signature have prognostic and predictive value. Advances in molecular characterization of solid tumors have made individualized approaches feasible. Personalized chemotherapy and targeted biological therapy based on tumor's individual biologic and molecular profile can optimize efficacy while minimizing toxicity. Molecular testing for activating mutations is routinely performed for several disease subtypes, including non-small cell lung cancer (NSCLC), breast cancer, melanoma and hematological malignancies including CML. For instance, alterations in the epidermal growth factor receptor (EGFR) domain and echinoderm microtubule associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) translocation are routinely used to guide therapeutic decisions for advanced NSCLC. Several new treatments targeting EGFR family members, novel EML4-ALK inhibitors and MEK inhibitors are currently in clinical development. Availability of targeted therapies makes it easier to integrate early palliative and supportive care in the management of patients with advanced malignancies. This review summarizes recent advances in use of targeted therapy, with a focus on NSCLC and a special emphasis on investigational strategies for individualized treatment, especially in patients with metastatic disease.