Non-small cell lung cancer (NSCLC) is a type of lung cancer that is mainly caused due to smoking. The treatment of NSCLC depends on the stage of cancer and the extent of the tumor spread. There are various treatments for NSCLC and one of the new forms of treatment is targeted therapy. Targeted therapy is a process that targets the specific genes of cancer or the tissue that can cause further growth of cancer.

Targeted therapy restricts the spread of cancer cells and also prevents damage to the healthy cells. Targeted therapy for NSCLC includes three options – anti-angiogenesis therapy, epidermal growth factor receptor (EGFR) inhibitors and medications that target other genetic changes:

1. Anti-angiogenesis therapy
Angiogenesis is a process of making new blood vessels. Anti-angiogenesis therapy aims to prevent angiogenesis. A tumor requires nutrients, which are delivered by the blood vessels. If the tumor acquires this nutrient, it can grow and spread easily. The anti-angiogenesis therapy uses certain medications to make the tumor starve for nutrients. The following are a few anti-angiogenic medicines used for NSCLC:

  • Bevacizumab (Avastin, Mvasi) – Bevacizumab is an anti-angiogenic medicine that is given along with chemotherapy for NSCLC.
  • Ramucirumab (Cyramza) – Ramucirumab is given along with the chemotherapy medication called docetaxel for NSCLC.

2. Epidermal growth factor receptor (EGFR) inhibitors
Epidermal growth factor receptor inhibitors use certain medications that block EGFR, which further slows down and stops the growth of lung cancer. The common EGFR inhibitors medications used for NSCLC are as follows:

  • Afatinib (Gilotrif) – Afatinib is a type of medicine known as a tyrosine kinase inhibitor (TKI), which is used during the initial targeted therapy for NSCLC. This medicine is also recommended for patients who have already undergone other treatments for squamous NSCLC.
  • Dacomitinib (Vizimpro) – Dacomitinib is used during initial treatment for NSCLC that has an EGFR alteration. However, this medicine is not always recommended.
  • Erlotinib (Tarceva) – Erlotinib is a prescription that is more effective than chemotherapy in the case of NSCLC that has EGFR gene alteration. This medication is mostly suggested for patients with metastatic or locally advanced NSCLC.
  • Gefitinib (Iressa) – Gefitinib is another medication used in targeted therapy for NSCLC.
  • Necitumumab (Portrazza) – Necitumumab is recommended along with chemotherapy.
  • Osimertinib (Tagrisso) – Osimertinib is mostly the first treatment option if the tumors have EGFR alteration in people with NSCLC. Osimertinib is also used in treating metastatic NSCLC with an EGFR alteration.

3. Medications that target other genetic changes
Targeting other genetic changes in tumors helps in slowing down and stopping the growth of NSCLC. Example of targeting other genetic changes is mentioned below:

  • Anaplastic lymphoma kinase (ALK) inhibitors – About 5% of people with NSCLC have alterations in the ALK gene. Medications that target changes in this type of gene are called ROS1. A particular genetic change is called an NTRK fusion.

Following are the medications that are used to target other genetic changes:

  • Alectinib (Alecensa) targets the mutation of the ALK gene.
  • Brigatinib (Alunbrig) targets the mutation of the ALK gene.
  • Ceritinib (Zykadia) targets the mutation of the ALK gene.
  • Dabrafenib (Tafinlar) and trametinib (Mekinist) combinations target BRAF V600E gene mutations. These medications do not target ROS1 or ALK mutations.
  • Crizotinib (Xalkori) targets mutations of ALK or ROS1 genes.
  • Larotrectinib (Vitrakvi) targets the fusion of the NTRK gene.
  • Lorlatinib (Lorbrena) targets mutations of ALK gene mutations.