What targeted therapies are available for Lung Cancer

Targeted Therapies for Lung Cancer

Targeted therapies are an important treatment option for lung cancer patients, especially those with specific genetic mutations (called "driver mutations"). These drugs work differently than traditional chemotherapy—they target the specific proteins that help cancer cells grow.

How Targeted Therapy Works

According to the NCCN Guidelines for Non-Small Cell Lung Cancer, targeted therapies work by identifying and stopping specific proteins that drive cancer cell growth. Think of it like this: cancer cells have "broken switches" (mutations) that tell them to keep growing. Targeted drugs are designed to flip those switches off.

Key Driver Mutations and Their Treatments

Your oncologist will recommend molecular testing (genetic testing of your tumor) to identify which mutations you have. Here are the main ones:

EGFR Mutations (Most Common)

These are found in about 10-15% of lung cancers, especially in never-smokers and adenocarcinoma types.

Treatment options include:

• Osimertinib (Tagrisso) - often preferred as first-line therapy
• Erlotinib (Tarceva)
• Gefitinib (Iressa)
• Afatinib (Gilotrif)
• Dacomitinib (Vizimpro)

According to NCCN Guidelines, osimertinib is often recommended because it works well against multiple EGFR mutations and can cross into the brain to treat brain metastases.

ALK Rearrangements

Found in 3-5% of lung cancers, particularly in never-smokers.

Treatment options include:

• Alectinib (often preferred first-line)
• Brigatinib
• Ceritinib
• Crizotinib
• Lorlatinib
• Ensartinib

KRAS Mutations

Found in about 30% of lung cancers, particularly in smokers.

Treatment options include:

• Sotorasib - targets KRAS G12C mutations specifically
• Adagrasib - another KRAS G12C inhibitor

ROS1 Rearrangements

Found in 1-2% of lung cancers.

Treatment options include:

• Crizotinib
• Entrectinib
• Repotrectinib
• Taletrectinib

BRAF Mutations

Found in 1-3% of lung cancers.

Treatment option:

• Dabrafenib plus Trametinib (combination therapy)

MET Exon 14 Skipping

Found in 3-4% of lung cancers.

Treatment options include:

• Capmatinib
• Tepotinib

EGFR Exon 20 Insertions

A specific type of EGFR mutation.

Treatment option:

• Amivantamab-vmjw (Rybrevant) - an antibody-drug conjugate that combines two drugs in one medicine

RET Rearrangements

Found in 1-2% of lung cancers.

Treatment options include:

• Selpercatinib
• Pralsetinib

NTRK Fusions

Rare, found in less than 1% of lung cancers.

Treatment option:

• Larotrectinib or Entrectinib

HER2 (ERBB2) Mutations

Found in 2-4% of lung cancers.

Treatment options include:

• Trastuzumab (Herceptin) - often combined with chemotherapy
• Pertuzumab

How These Drugs Are Given

According to NCCN Guidelines:

• Kinase inhibitors are pills you take at home
• Antibody therapies are given by infusion (slow drip into a vein) at a healthcare center
• Antibody-drug conjugates are also given by infusion

Important Considerations

Timing matters: According to NCCN Guidelines, if you've already started immunotherapy, there may be a short delay needed before starting certain targeted therapies (like osimertinib) to prevent side effects.

Testing is critical: The NCCN Guidelines strongly recommend broad molecular profiling—testing for ALL actionable mutations—before starting treatment. This can be done through:

• Tissue biopsy
• Blood tests (liquid biopsy/plasma testing)
• Or a combination of both

Resistance can develop: After months or years on targeted therapy, cancer may start growing again. Your doctor may recommend additional testing to see if new mutations have developed, and treatment may be adjusted accordingly.

Questions to Ask Your Oncologist

1. What specific mutations does my tumor have? (Ask for the complete molecular testing results)
2. Which targeted therapy do you recommend for my specific mutations, and why?
3. What are the expected side effects, and how are they managed?
4. How long do patients typically stay on this therapy before resistance develops?
5. What happens if my cancer starts growing again while on targeted therapy?
6. Are there clinical trials available for my mutation type?

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.