Novel Therapeutics Aspects In Advanced And Metastatic Non-Small Cell Lung Cancer - Experience Of Oncology Department Of Chronic Disease St. Luke'S Hospital Bucharest

IntroductionBronchopulmonary cancer remains the leading cause of cancer death all over the world. The molecular analysis and the identification of different genetic mutations/alterations of tumour cell, discovering new targeted therapies, changed the treatment algorithm, especially for patients with NSCLC. As well as, lung cancer is characterized by a strongly immunosuppressive microenvironment, leading to the introduction in the landscape of treatment management of NSCLC of immune checkpoint inhibitors.Material and MethodsIn 2018-2019 periods, 558 patients with lung cancer were admitted to Department of Oncology from Chronic Disease "St. Luke" Hospital, Bucharest. Only 276 patients were admitted for specific oncological treatment, most of them with NSCLC. Therapeutic decisions for patients with NSCLC was based on molecular analysis of the biological samples and, in some cases, required the administration of novel therapies, according to the reimbursement and the specific protocols in Romania.Results and DiscussionsOnly 8,33 % patients (23/276) with advanced/metastatic lung cancer were eligible for targeted therapy or immunotherapy. Patients in treatment with targeted therapies had clinical benefit, partial remission or stationary disease, but with the development of treatment resistance, mainly after 5-6 months. Step by step, we implemented immunotherapy to NSCLC patients, and the identification and management of immunological adverse reactions remains a challenge.ConclusionsThe discovery of EGFR mutations in lung cancer tumour cells and, subsequently, of a specific treatment - TKIs - revolutionized the treatment of NSCLC patients. EGFR TKIs and ALK TKIs have shown significant benefit in the treatment of a subset of patients with lung cancer. Immunotherapy tends to become the standard in the treatment of patients with bronchopulmonary cancer, either in monotherapy or in combination with conventional chemotherapy.