Targeted therapy is the name for anticancer treatments that interfere with how a cancer grows and spreads when a very specific abnormality is present. These treatments work in a different way than standard chemotherapy. (See "Personalized, genotype-directed therapy for advanced non-small cell lung cancer".)
The decision about which targeted therapy, if any, to use depends on your particular cancer. Generally, a sample of your tumor that was obtained by surgery or biopsy is analyzed in the laboratory to make this decision. When such an abnormality is present, the likelihood of a favorable response to treatment is much higher than with older forms of treatment such as chemotherapy.
Testing can be done to see if your cancer belongs to one of the categories that is likely to respond to targeted therapy.
●Epidermal growth factor receptor (EGFR) mutations – When the epidermal growth factor receptor contains a particular abnormality (mutation), this change can stimulate growth and spread of the tumor. If an abnormality in EGFR is found, targeted therapy is generally used instead of standard chemotherapy. People in this category are usually treated with a drug called a tyrosine kinase inhibitor (TKI). Examples of TKIs include osimertinib (brand name: Tagrisso), erlotinib (brand name: Tarceva), gefitinib (brand name: Iressa), and afatinib (brand name: Gilotrif). The most common side effects of TKIs are skin rash and diarrhea. (See "Systemic therapy for advanced non-small cell lung cancer with an activating mutation in the epidermal growth factor receptor".)
●Anaplastic lymphoma kinase (ALK) gene abnormalities – A fusion (combination) of the ALK gene with another gene such as EML can drive the growth of some non-small cell lung cancers. Crizotinib (brand name: Xalkori) is a targeted medicine that blocks the cancer stimulus caused by this ALK abnormality. Crizotinib is more effective than standard chemotherapy in patients with lung cancer containing this abnormality, and thus crizotinib is generally recommended as the initial therapy instead of standard chemotherapy in this situation. Crizotinib is generally well tolerated, and the most common side effects of crizotinib are mild changes in vision and nausea, vomiting, and diarrhea. (See "Anaplastic lymphoma kinase (ALK) fusion oncogene positive non-small cell lung cancer", section on 'Crizotinib'.)
●ROS-1 abnormalities – An abnormality in the ROS-1 gene is present in another set of patients with non-small cell lung cancer. Crizotinib (Xalkori) has been found to be effective in many people in this group as well.
●Other specific abnormalities (such as mutations in HER2, BRAF, MET, or RET) may be suitable for specific targeted treatments, and other mutations are being identified. In some cases, you may want to consider participating in a clinical trial of new agents if your tumor contains one of these abnormalities.
If your initial treatment with a targeted agent does not work, or if you initially respond and then your disease progresses, your doctor may recommend treatment with chemotherapy.