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Treatment

Targeted Therapies

Targeted therapies are a type of personalized medicine that specifically target genetic biomarkers (indicators of lung cancer presence ) in cancer cells.

Learn: What is a biomarker? What is the difference between targeted therapy and chemotherapy? How do you know if targeted therapy is right for you?

Does Targeted Therapy Mean I Don't Need Chemotherapy?

Targeted therapy is revolutionizing treatment for lung cancer patients. Discover how targeted therapy is different from chemotherapy and learn how it can be used as an alternative or in combination with traditional treatments.

About

Targeted therapies are a form of personalized medicine that is bringing great hope to lung cancer patients. Targeted therapies have been found to have great benefit and fewer side effects while giving lung cancer patients more options for treatment.

Targeted therapy for lung cancer is one of the most important research discoveries bringing hope to lung cancer patients and their families. Targeted therapies are treatments that specifically target mutational changes in cancer cells. New targeted therapies for lung cancer are being discovered that may be used alone, before or after, or in combination with traditional chemotherapy, radiation, or surgery.

What Makes Them “Personalized”?

Targeted therapy is sometimes called precision medicine or personalized medicine. Looking at each patient’s tumor with its unique molecular profile allows thoracic oncologists to determine a personalized plan of treatment that will work best for an individual patient.  Researchers are rapidly learning how to use this knowledge to match the best treatment for each individual patient. Many potential drug targets have already been identified, with more being identified all the time. This is a significant step forward toward personalizing cancer care.

Types of Treatment

Targeted therapies for lung cancer play a crucial role in the treatment of the disease. Unlike traditional chemotherapy, which attacks both cancerous and healthy cells, targeted therapies specifically target the genetic mutations or abnormalities that drive the growth of cancer cells. This personalized approach allows for more effective and precise treatment, minimizing damage to healthy tissues and reducing side effects. By identifying specific molecular targets unique to each patient’s cancer, targeted therapies offer the potential for increased treatment response rates and improved outcomes. Additionally, targeted therapies have shown promise in overcoming resistance to traditional treatments, providing new options for patients who may have limited treatment options. Overall, targeted therapies represent a significant advancement in the fight against lung cancer, offering hope for improved survival and quality of life for patients.

Targeted therapy is sometimes called precision medicine or personalized medicine. Looking at each patient’s tumor with its unique molecular profile that is the result of any number of mutations that can happen in the genes of cancer cells. Patient A’s cancer may have mutation X, while Patient B’s may have mutation Y, and so on. This means that what works for one patient with lung cancer may not work for another. Researchers are rapidly learning how to use this knowledge to match the best treatment for each individual patient.

By evaluating the mutations that occur in a lung cancer cell’s genome responsible for driving the uncontrolled growth and spread of these cells, drugs have been developed and approved that overcome these mutations and resulting changes in cellular processes. These Targeted Therapies include inhibitors for biomarkers such as EGFR, ALK, ROS1 and KRAS.

Researchers are learning more about what makes lung cancer cells form, grow, and spread. Every cell in the body has the same library of genes that acts as the blueprint for everything else that makes up a cell and makes it work. In cancer cells, damage to these genes (mutations) is responsible for the cells becoming cancerous.

Some of these mutations create proteins in cells that act like a stuck gas pedal in your car to make it drive out of control. These mutant proteins in cancer cells are good “targets” for new drugs known as Targeted Therapies.

Targeted therapies work by blocking these mutant proteins, which prevents them from growing and spreading, while not harming normal cells.

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What to Expect

Targeted therapy has revolutionized the treatment of lung cancer, offering new hope and improved outcomes for patients. Unlike traditional chemotherapy, targeted therapy works by identifying specific genetic mutations or abnormalities in cancer cells and targeting them directly. This personalized approach can lead to better treatment responses and fewer side effects.

If you are beginning targeted therapy for lung cancer, here’s what you can expect:

  1. Genetic Testing: Before starting targeted therapy, your healthcare team will perform genetic testing to identify specific mutations or alterations in your cancer cells. This will help determine if you are a candidate for targeted therapy and which drugs are most likely to be effective for your cancer type.
  2. Treatment Plan: Once the genetic testing results are available, your healthcare team will develop a personalized treatment plan tailored to your specific lung cancer. This plan may involve one or a combination of targeted therapy drugs, depending on the genetic profile of your cancer cells.
  3. Administration: Targeted therapy drugs are usually taken orally, in the form of pills or capsules. The frequency and duration of treatment will depend on the specific drug and your individual treatment plan. Your healthcare team will provide detailed instructions on how and when to take your medication.
  4. Monitoring and Follow-up: Regular monitoring is crucial during targeted therapy treatment. Your healthcare team will schedule periodic check-ups, including imaging tests and blood work, to assess the response to treatment and monitor for any potential side effects. It is important to attend all scheduled appointments and communicate any concerns or changes in your health to your healthcare provider.
  5. Treatment Response: Targeted therapy can lead to significant tumor shrinkage and disease control in many lung cancer patients. However, the response to targeted therapy varies from person to person. Some patients may experience a rapid and dramatic response, while others may have a more gradual or stable disease course. It is essential to have realistic expectations and understand that individual responses may differ.
  6. Lifestyle Adjustments: During targeted therapy, it is important to prioritize self-care and make necessary lifestyle adjustments. This may include maintaining a healthy diet, staying physically active within your capabilities, managing stress, and getting enough rest. Your healthcare team can provide guidance on lifestyle modifications that can support your overall well-being during treatment.

Targeted therapy has transformed the treatment landscape for lung cancer patients. Starting targeted therapy involves genetic testing, personalized treatment plans, regular monitoring, and potential side effects. It is essential to work closely with your healthcare team, communicate openly, and adhere to the prescribed treatment plan. By doing so, you can maximize the benefits of targeted therapy and improve your overall quality of life.

Side Effects

While targeted therapy is generally well-tolerated, it can still cause side effects. The side effects associated with targeted therapy are often different from those of traditional chemotherapy. Common side effects may include skin rashes, diarrhea, fatigue, and changes in liver function. It is important to report any side effects to your healthcare team promptly, as they can provide guidance and support to manage these symptoms.

FDA-Approved Targeted Therapies Treatment

Types

  • Ipilimumab (Yervoy)

    Ipilimumab (Yervoy) is a special drug that helps fight lung cancer by the immune system attacking cancer cells. It’s used for NSCLC that has:

    • Spread to other parts of the body
    • A protein called PD-L1
    • No changes in genes called EGFR or ALK

     

    Ipilimumab can be used:

    • As a first treatment for some patients
    • With other cancer drugs called chemotherapy
    • Before surgery (neo-adjuvant) for early-stage NSCLC

    Approved for: NSCLC

    Biomarkers: PD-L1

    FDA Approval Date: 05/26/2020

    Used in: Adjuvant Therapy, Combination Therapy, Targeted Therapy

  • Repotrectinib (Augtyro)

    Repotrectinib (Augtyro) for locally advanced or metastatic ROS1-positive non-small cell lung cancer (NSCLC) that includes patients with ROS1-positive NSCLC who have previously received a ROS1 tyrosine kinase inhibitor (TKI), in addition to patients who are TKI naïve.

    Also used in the treatment of tumors with NTRK gene fusions, Repotrectinib is a next-generation TRK inhibitor approved for patients with NTRK-positive locally advanced or metastatic solid tumors.

    Approved for: NSCLC

    Biomarkers: NTRK, ROS1

    FDA Approval Date: 11/15/2023

    Used in: Targeted Therapy

  • Adagrasib (Krazati)

    FDA granted accelerated approval to adagrasib, a RAS GTPase family inhibitor, for adult patients with KRAS G12C-mutated locally advanced or metastatic non-small cell lung cancer (NSCLC) who have received at least one prior systemic therapy.

    Approved for: NSCLC

    Biomarkers: KRAS G12C

    FDA Approval Date: 12/01/2022

    Used in: Targeted Therapy

  • Pralsetinib (Gavreto)

    FDA granted regular approval to pralsetinib for adult patients with metastatic rearranged during transfection (RET) fusion-positive non-small cell lung cancer (NSCLC).

    Approved for: NSCLC

    Biomarkers: RET

    FDA Approval Date: 08/01/2023

    Used in: Targeted Therapy

  • Atezolizumab (Tecentriq)

    FDA approved atezolizumab for adjuvant treatment following resection and platinum-based chemotherapy in patients with stage 2 to 3A non-small cell lung cancer (NSCLC) whose tumors have PD-L1 expression on ≥ 1% of tumor cells.

    Approved for: NSCLC

    Biomarkers: PD-L1

    FDA Approval Date: 10/01/2021

    Used in: Targeted Therapy

  • Fam-trastuzumab deruxtecan-nxki

    FDA granted accelerated approval to fam-trastuzumab deruxtecan-nxki for adult patients with unresectable or metastatic non-small cell lung cancer (NSCLC) whose tumors have activating human epidermal growth factor receptor 2 HER2 (ERBB2) mutations, and who have received a prior systemic therapy. This is the first drug approved for HER2-mutant NSCLC.

    Approved for: NSCLC

    FDA Approval Date: 08/01/2022

    Used in: Targeted Therapy

  • Capmatinib (Tabrecta)

    FDA granted regular approval to capmatinib for adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have a mutation leading to mesenchymal-epithelial transition (MET) exon 14 skipping.

    Approved for: NSCLC

    Biomarkers: MET Exon 14 Skipping

    FDA Approval Date: 08/01/2022

    Used in: Targeted Therapy

  • Selpercatinib (Retevmo)

    FDA granted regular approval to selpercatinib for adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with a rearranged during transfection (RET) gene fusion.

    Approved for: NSCLC

    Biomarkers: RET

    FDA Approval Date: 09/01/2022

    Used in: Targeted Therapy

  • Mobocertinib

    The FDA has approved mobocertinib for the treatment of adult patients with locally advanced or metastatic non–small cell lung cancer with EGFR exon 20 insertion mutations as detected by an FDA-approved test, whose disease has progressed on or after platinum-based chemotherapy.

    Approved for: NSCLC

    Biomarkers: EGFR Exon 20 insertion

    FDA Approval Date: 09/01/2021

    Used in: Targeted Therapy

  • Osimertinib (Tagrisso)

    Adjuvant therapy for NSCLC patients who have undergone resection and have tumors positive for either EGFR exon 19 or exon 21 L858R.

    Approved for: NSCLC

    Biomarkers: EGFR Exon 19, EXON 21 L858R

    FDA Approval Date: 10/30/2023

    Used in: Targeted Therapy

  • Atezolizumab (Tecentriq)

    Non-small cell lung cancer that has metastasized. It is used:

    As first-line therapy in adults whose cancer has the PD-L1 protein and does not have a mutation in the EGFR gene or the ALK gene.

    In adults whose cancer has gotten worse during or after treatment with platinum chemotherapy.

    For patients whose cancer has a mutation in the EGFR gene or ALK gene, atezolizumab is used if their disease has gotten worse after treatment with FDA-approved therapy for these mutations.

    Approved for: NSCLC

    Biomarkers: PD-L1

    FDA Approval Date: 10/31/2023

    Used in: Combination Therapy, Targeted Therapy

  • Brigatinib (Alunbrig)

    Non-small cell lung cancer that is ALK positive and has metastasized (spread to other parts of the body). It is used in adults.

    Approved for: NSCLC

    Biomarkers: ALK

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Capmatinib (Tabrecta)

    Non-small cell lung cancer that has a certain mutation in the MET gene. It is used in adults whose disease has metastasized.

    Approved for: NSCLC

    Biomarkers: MET

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Selpercatinib (Retevmo)

    Non-small cell lung cancer that has a RET fusion gene and is metastatic. It is used in adults.

    Approved for: NSCLC

    Biomarkers: RET

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Pralsetinib (Gavreto)

    Non-small cell lung cancer that has a RET fusion gene and is metastatic. It is used in adults.

    Approved for: NSCLC

    Biomarkers: RET

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Tepotinib (Tepmetko)

    For the treatment of adults with metastatic non-small cell lung cancer (NSCLC) who are harboring mesenchymal-epithelial transition (MET) exon 14 skipping alterations.

    Approved for: NSCLC

    Biomarkers: MET Exon 14 Skipping

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Amivantamab

    The FDA has approved amivantamab-vmjw (Rybrevant) as the first treatment for adult patients with non–small cell lung cancer (NSCLC) who harbor EGFR exon 20 insertion mutations.

    Approved for: NSCLC

    Biomarkers: EGFR Exon 20 insertion

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Sotorasib

    Sotorasib is the first treatment for adult patients with non–small cell lung cancer whose tumors harbor KRAS G12C mutations and who have received at least 1 prior systemic therapy.

    Approved for: NSCLC

    Biomarkers: KRAS G12C

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Ramucirumab (Cyramza)

    Non-small cell lung cancer that has metastasized. It is used:
    With erlotinib hydrochloride as first-line therapy in patients whose disease has certain mutations in the EGFR gene. With docetaxel in patients whose disease has gotten worse during or after treatment with platinum chemotherapy. For patients whose disease has a mutation in the EGFR gene or ALK gene, ramucirumab is used if their disease has gotten worse after treatment with FDA-approved therapy for these mutations.

    Approved for: NSCLC

    Biomarkers: ALK, EGFR

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Alectinib (Alecensa)

    Non-small cell lung cancer that is ALK-positive and has metastasized (spread to other parts of the body).

    FDA approved alectinib (Alecensa) for people with non-small cell lung cancer (NSCLC) who have ALK-positive tumors that can be removed with surgery. Based on the ALINA trial results, the Food and Drug Administration (FDA) approved alectinib as adjuvant therapy for people with ALK-positive NSCLC.

    Approved for: NSCLC

    Biomarkers: ALK

    FDA Approval Date: 09/30/2024

    Used in: Adjuvant Therapy, Targeted Therapy

  • Afatinib (Gilotrif)

    Non-small cell lung cancer (NSCLC) that has metastasized (spread to other parts of the body). It is used:
    As first-line treatment in patients with tumors that have certain EGFR gene mutations.

    Approved for: NSCLC

    Biomarkers: EGFR

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Nivolumab (Opdivo/Opdivo Injection)

    Nivolumab, alone or with Ipilimumab, is an
FDA-approved immunotherapy option or combination to treat many types of non-small cell lung cancer (NSCLC).

    It is used:

    • As first-line therapy with ipilimumab in adults whose cancer is metastatic and has the PD-L1 protein but does not have mutations in the EGFR or ALK gene.
    • As first-line therapy with ipilimumab and platinum chemotherapy in adults whose cancer is metastatic or recurrent but does not have mutations in the EGFR or ALK gene.
    • In patients whose cancer is metastatic and has gotten worse during or after treatment with platinum chemotherapy. Patients whose cancer has a mutation in the EGFR or ALK gene should receive nivolumab only if their disease got worse after treatment with FDA-approved therapy for these gene mutations.

    Approved for: NSCLC

    Biomarkers: PD-L1

    FDA Approval Date: 09/27/2024

    Used in: Adjuvant Therapy, Combination Therapy, Targeted Therapy

  • Dacomitinib (Vizimpro)

    Non-small cell lung cancer (NSCLC) that has metastasized (spread to other parts of the body). It is used as first-line treatment in patients whose tumors have certain EGFR gene mutations.

    Approved for: NSCLC

    Biomarkers: EGFR

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Lorlatinib (Lorbrena)

    Non-small cell lung cancer that is ALK positive and has metastasized (spread to other parts of the body). It is used in patients whose disease got worse after treatment with: Crizotinib and at least one other ALK inhibitor therapy for metastatic disease, or Alectinib or ceritinib as the first ALK inhibitor therapy for metastatic disease. In March, 2021 also approved to include frontline treatment for patients with anaplastic lymphoma kinase (ALK)-positive metastatic NSCLC.

    Approved for: NSCLC

    Biomarkers: ALK, ROS1

    FDA Approval Date: 11/03/2023

    Used in: Targeted Therapy

  • Larotrectinib (Vitrakvi)

    non-small cell lung cancer (NSCLC) with neurotrophic receptor tyrosine kinase (NTRK) gene fusion.

    Approved for: NSCLC

    Biomarkers: NTRK

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Entrectinib (Rozlytrek)

    Non-small cell lung cancer that is ROS1 positive. It is used in adults whose cancer has metastasized (spread to other parts of the body).

    Approved for: NSCLC

    Biomarkers: ROS1

    FDA Approval Date: 11/19/2024

    Used in: Targeted Therapy

  • Docetaxel (Taxotere)

    Docetaxel, marketed as Taxotere, is a chemotherapy drug used in the treatment of lung cancer, specifically non-small cell lung cancer (NSCLC). First approved by the FDA for NSCLC in 1999, docetaxel works by disrupting the normal function of microtubules, which are essential for cell division, ultimately leading to cancer cell death. It is commonly used as a first-line treatment in combination with other agents, such as cisplatin, for advanced NSCLC, and can also be an effective option for patients whose cancer has progressed after initial treatments. Additionally, docetaxel is utilized in the second-line setting for NSCLC patients who have not achieved the desired response with prior therapies, offering a valuable alternative in their treatment plan.

    Approved for: NSCLC

    FDA Approval Date: 01/01/1999

    Used in: Chemotherapy, Combination Therapy, Immunotherapy, Targeted Therapy

  • Gefitinib (Iressa)

    Gefitinib, marketed as Iressa, is a targeted therapy used primarily for treating non-small cell lung cancer (NSCLC) in patients with specific genetic mutations. The FDA first approved gefitinib in 2003 for patients with advanced NSCLC whose tumors express the epidermal growth factor receptor (EGFR) mutation. This targeted therapy works by inhibiting the EGFR pathway, which is often overactive in certain types of lung cancer, leading to reduced tumor growth. Gefitinib is commonly used as a first-line treatment for patients with EGFR-mutant NSCLC. Additionally, it can be used in patients whose disease has progressed after other treatments, offering another option for managing advanced lung cancer.

    Approved for: NSCLC

    Biomarkers: EGFR

    FDA Approval Date: 01/01/2003

    Used in: Targeted Therapy

  • Erlotinib (Tarceva)

    Erlotinib, marketed as Tarceva, is a targeted therapy primarily used to treat non-small cell lung cancer (NSCLC), particularly in patients with specific genetic mutations. The FDA first approved erlotinib in 2004 for the treatment of advanced NSCLC in patients who had previously received at least one chemotherapy regimen. Erlotinib works by inhibiting the epidermal growth factor receptor (EGFR), which is often mutated in NSCLC, leading to reduced tumor growth and improved patient outcomes. It is commonly used as a first-line treatment for patients with EGFR-mutant NSCLC and can also be an effective second-line option for those whose disease has progressed after chemotherapy. Additionally, erlotinib is sometimes used in combination with other therapies, such as chemotherapy or targeted treatments, enhancing its effectiveness in managing advanced lung cancer. Its targeted approach emphasizes the importance of genetic testing in personalizing lung cancer treatment strategies.

    Approved for: NSCLC

    Biomarkers: EGFR

    FDA Approval Date: 01/17/2024

    Used in: Combination Therapy, Targeted Therapy

  • Bevacizumab (Avastin/Mvasi/Zirabev)

    Bevacizumab, marketed under names such as Avastin, Mvasi, and Zirabev, is a monoclonal antibody used in the treatment of non-small cell lung cancer (NSCLC). The FDA first approved bevacizumab in 2006 specifically for use in combination with chemotherapy for patients with advanced NSCLC. It works by inhibiting vascular endothelial growth factor (VEGF), which is crucial for tumor blood vessel formation. By blocking VEGF, bevacizumab helps to starve tumors of the nutrients they need to grow. In lung cancer treatment, bevacizumab is typically used in combination with carboplatin and paclitaxel or other chemotherapy regimens, making it a valuable option for patients with advanced disease.

    Approved for: NSCLC

    FDA Approval Date: 01/01/2006

    Used in: Chemotherapy, Combination Therapy, Targeted Therapy

  • Crizotinib (Xalkori)

    Non-small cell lung cancer that is ALK positiveor ROS1 positive and has metastasized (spread to other parts of the body).

    Approved for: NSCLC

    Biomarkers: ALK, ROS1

    FDA Approval Date: 11/03/2023

    Used in: Targeted Therapy

  • Ceritinib (Zykadia)

    Non-small cell lung cancer that is ALK positive and has metastasized (spread to other parts of the body). It is used in adults.

    Approved for: NSCLC

    Biomarkers: ALK, ROS1

    FDA Approval Date: 11/03/2023

    Used in: Targeted Therapy

  • Dabrafenib (Tafinlar)

    Non-small cell lung cancer that has metastasized. It is used with trametinib.Dabrafenib is used only in patients whose cancer has a certain mutation in the BRAF gene.

    Approved for: NSCLC

    Biomarkers: BRAF

    FDA Approval Date: 11/19/2024

    Used in: Combination Therapy, Targeted Therapy

  • Trametinib (Mekinist)

    Non-small cell lung cancer that has metastasized. It is used with dabrafenib.
    Trametinib is used only in patients whose cancer has a certain mutation in the BRAF gene.

    Approved for: NSCLC

    Biomarkers: BRAF

    FDA Approval Date: 11/19/2024

    Used in: Combination Therapy, Targeted Therapy