The type of therapy a patient is best suited for depends on their pathology and molecular characteristics: whether they have the molecular “actionable” mutations, a PDL1 greater or equal to 50%, or neither, according to a video from the National Comprehensive Cancer Network.

The molecular “actionable” genetic alterations which are FDA approved, include EGFR mutations, which has a current treatment standard of osimertinib. 

In ALK translocations, the NCCN currently prefers alectinib as it has a better and longer response with better brain activity.

For ROS translocations the only FDA approved agent is crizotinib and others are underway in clinical trials, according to the NCCN. In BRAF mutations, dabrafenib and trametinib are appropriate. With NTRK translocations, the recently approved treatment larotrectinib can be used. In mutations without FDA approval there are a selection of drugs available, which have been approved for other indications. 

In patients who may have MET amplification or exon 14 deletions, critzotinib has shown activity. In RET translocations, the following treatments may be effective: cabozantinib, lenvatinib, alectinib and ponatinib. In HER2 mutations which is discussed in breast cancer, in lung cancer it appears that TDM1 has activity against mutations, but it is not yet FDA approved. 

Video Source: Youtube
Video Content: National Comprehensive Cancer Network