Lung Cancer Fact Sheet Page 2
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NCCN Guidelines also recommend consideration of EGFR and ALK testing in patients with squamous cell
carcinoma, especially in patients who have never smoked, when small biopsy specimens were used to
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assess histology, or in mixed-histology tumors.
EGFR mutations occur in 10 to 20 percent of NSCLC tumors
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and as high as 60 percent in NSCLC
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tumors in Asian populations.
Epidemiology studies suggest that approximately 3 to 5 percent of NSCLC tumors are ALK-positive.
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Pfizer supports testing for all clinically relevant biomarkers during treatment planning, as testing is
increasingly important to patients with metastatic NSCLC and will help guide treatment decisions that may
lead to improved patient care.
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In April 2013, an evidence based guideline issued by the College of American Pathologists (CAP),
International Association for the Study of Lung Cancer (IASLC) and Association for Molecular
Pathology (AMP) emphasized the importance of routine molecular testing in metastatic NSCLC
adenocarcinoma diagnosis and treatment.
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According to the guideline, doctors should order EGFR mutation and ALK rearrangement testing at
the time of adenocarcinoma diagnosis for patients who present with metastatic NSCLC, regardless
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of their clinical history.
NSCLC Treatment
Current treatment options for NSCLC include surgery, radiofrequency ablation, radiation therapy,
chemotherapy, biomarker-driven therapy and immunotherapy. In some cases, more than one kind of treatment
is used.
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With the identification and increased understanding of molecular abnormalities in lung cancer, research
efforts have focused on identifying biomarker targets and using this knowledge to develop biomarker-
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driven therapies and guide treatment decisions.
At the same time, the oncology community is continuing
to better understand how tumor histology plays a role in treatment outcomes and how each of these
factors must be considered in order to choose the most appropriate therapy for each individual.
Targets currently being used or investigated in the treatment of NSCLC include the human epidermal
growth factor (HER) family of receptors, EGFR, ERCC1, KRAS, ALK, BRAF, PI3KA, IGF-1R, c-MET,
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ROS-1 and RET.
* Category 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
1
National Cancer Institute at the National Institute of Health website. Lung Cancer. 2009.
Accessed March 25, 2015.
2
Reade CA, Ganti AK. EGFR targeted therapy in non-small cell lung cancer: potential role of cetuximab. Biologics. 2009; 3: 215–224.
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World Health Organization website. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence,
Mortality and Prevalence Worldwide in 2012. (Select Lung from drop down
menu). Accessed March 25, 2015.
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World Health Organization website. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated Cancer Incidence,
Mortality and Prevalence Worldwide in 2012. (Select All Cancers from drop down
menu). Accessed March 25, 2015.
5
American Cancer Society website. Cancer Facts and Figures 2015. Available at:
Accessed on March 27, 2015.
6
World Health Organization website. International Agency for Research on Cancer. GLOBOCAN 2008: Estimated Cancer Incidence,
Mortality and Prevalence Worldwide in 2012. (select ‘World’ from the drop
down menu under ‘Fact Sheets’). Accessed March 25, 2015.
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American Cancer Society website. Global Cancer Facts and Figures 2011. Available at:
8
American Cancer Society website. Detailed Guide: Lung Cancer (Non-Small Cell).
Accessed March 31, 2015.
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Samet, J, Avila-Tang, E, Boffetta, A, et al. Lung Cancer in Never Smokers: Clinical Epidemiology and Environmental Risk
Factors. Clinical Cancer Research. 2009; 15: 5626.
10
National Comprehensive Cancer Network website. NCCN Clinical Practice Guidelines in Oncology: Lung Cancer Screening Version
1.2013.
Accessed August 7, 2013.
11
Pao W, Miller VA. Epidermal growth factor receptor mutations, small-molecule kinase inhibitors, and non-small-cell lung cancer: current
knowledge and future directions. J Clin Onc. 2005; 23:2556-2568.
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Mok T, Thongprasert S, Yang C, et al. Gefitinib or Carboplatin–Paclitaxel in Pulmonary Adenocarcinoma. N Engl J Med, 2009; 361:947-
957.
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Garber K. ALK, lung cancer, and personalized therapy: portent of the future? J Natl Cancer Inst. 2010; 102:672-675.
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May 2015
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