Challenges in Implementing Personalized Medicine for Lung Cancer within a National Healthcare System
Abstract
:1. Introduction
2. Traditional Approach to the Treatment of NSCLC
3. Personalized Approaches to the Treatment of NSCLC
3.1. The Impact of Histology on Treatment Decisions
3.2. Molecular Profiling of NSCLC
3.3. Treatment Directed by KRAS Mutation
3.4. EGFR Directed Therapy
Trial | Treatment | Population | RR | PFS (m) | PFS (HR) | OS (m) | QoL |
---|---|---|---|---|---|---|---|
IPASS [36] | Gef vs. Cb/Pac | Mut+ | 71% vs . 47% | 0.48 | 18.8 vs. 17.4 | | |
Mut- | 1% vs . 23% | 2.85 | |||||
First Signal [38] | Gef vs. Cis/Gem | Mut+ | 85% vs . 37% | 0.61 | 22.3 vs. 22.9 | | |
Mut- | 26% vs . 52% | 1.52 | |||||
NEJ002 [42] | Gef vs. Cb/Pac | Mut+ | 74% vs. 31% | 10.8 vs. 5.4 | 0.30 | 30.5 vs. 23.6 | |
WJTOG 3405 [39] | Gef vs. Cis/Doc | Mut+ | 62% vs. 32% | 9.2 vs. 6.3 | 0.49 | NR | NR |
Optimal [43] | Erl vs. Cb/Gem | Mut+ | 83% vs. 36% | 13.1 vs. 4.6 | 0.16 | NR | NR |
EURTAC [40] | Erl vs. plt doub | Mut+ | 58% vs. 15% | 9.7 vs. 5.2 | 0.37 | 19.3 vs. 19.5 | NR |
LUX-LUNG 3[41] | Afa vs. Cis/Pem | Mut+ | 56% vs. 23% | 11.1 vs. 6.9 | 0.58 | NR | |
Trial | Treatment | Overall | Grade 5 | ||
---|---|---|---|---|---|
Grade 3-5 | Toxicity | ||||
TKI | Chemo | TKI | Chemo | ||
28.7% | 61% | 3.8% | 2.7% | ||
First Signal [38] | Gef vs. Cis/Gem | 28.9% | 68% | 1.3% | 0.7% |
NEJ002 [42] | Gef vs. Cb/Pac | 41.2% | 71.7% | 0.9% | 0% |
WJTOG 3405 [39] | Gef vs. Cis/Doc | NR | NR | 1.1% | 0% |
Optimal [43] | Erl vs. Cb/Gem | 17% | 65% | 0% | 0% |
EURTAC [40] | Erl vs. plt doub | 45% | 67% | 1% | 2% |
LUX-LUNG 3 [41] | Afa vs. Cis/Pem | 60.7% | 56.8% | 1.7% | 0% |
3.5. Other Molecularly Targeted Therapy
4. Challenges to Implementing Personalized Treatment Approaches for the Treatment of NSCLC
4.1. Cost-Effectiveness
4.2. Biomarker Testing and Patient Identification
4.3. Adequate Tissue Samples
4.4. Workload of Specialists
4.5. Reliability of Subtyping
4.6. Choice of Test
4.7. Funding
5. Future Directions
Conflict of Interest
References
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Dawe, D.E.; Ellis, P.M. Challenges in Implementing Personalized Medicine for Lung Cancer within a National Healthcare System. J. Pers. Med. 2012, 2, 77-92. https://doi.org/10.3390/jpm2030077
Dawe DE, Ellis PM. Challenges in Implementing Personalized Medicine for Lung Cancer within a National Healthcare System. Journal of Personalized Medicine. 2012; 2(3):77-92. https://doi.org/10.3390/jpm2030077
Chicago/Turabian StyleDawe, David E., and Peter M. Ellis. 2012. "Challenges in Implementing Personalized Medicine for Lung Cancer within a National Healthcare System" Journal of Personalized Medicine 2, no. 3: 77-92. https://doi.org/10.3390/jpm2030077
APA StyleDawe, D. E., & Ellis, P. M. (2012). Challenges in Implementing Personalized Medicine for Lung Cancer within a National Healthcare System. Journal of Personalized Medicine, 2(3), 77-92. https://doi.org/10.3390/jpm2030077