CHEST Guidelines-A-Survey-of-Japanese-Thoracic-Oncologists'-Percept

A-Survey-of-Japanese-Thoracic-Oncologists'-Percept

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The correspondence within the December 2014 edition of "CHEST" discusses a survey conducted among Japanese thoracic oncologists regarding their perceptions of diagnostic and treatment strategies for non-small cell lung cancer (NSCLC) with specific genetic alterations, namely EGFR mutations and EML4-ALK fusions. These genetic abnormalities have spurred the development of targeted therapies, specifically EGFR- and ALK-tyrosine kinase inhibitors (TKIs).<br /><br />In 2012, 871 oncologists participated in a self-administered questionnaire designed to understand prevailing clinical practices. The survey revealed that a majority of oncologists (89% for EGFR and 60% for ALK) recognized the importance of genetic testing at diagnosis, although opinions differed on the ideal patient population for these tests. Additionally, while half of the respondents favored using gefitinib over platinum-based chemotherapy for EGFR-mutant NSCLC due to its perceived benefits in progression-free survival and quality of life, others preferred chemotherapy when patient performance status was retained.<br /><br />For ALK-rearranged NSCLC, 44% preferred crizotinib as a first-line treatment, valuing its previously demonstrated efficacy in prolonging progression-free survival, although 51% opted for chemotherapy given a patient's good condition. While there was consensus on using targeted therapies early, discrepancies remained concerning treatment sequences.<br /><br />The findings underscore a general agreement on the significance of driver oncogene-based therapies in early treatment for NSCLC, with ongoing debate on optimal sequencing. The authors, associated with various Japanese medical institutions, suggest further study to understand evolving perceptions as medical practices and guidelines advance. Their work reflects the continually evolving landscape of personalized oncology, emphasizing the critical role of genetic testing in crafting effective treatment plans.

Keywords

non-small cell lung cancer

NSCLC

EGFR mutations

EML4-ALK fusions

targeted therapies

tyrosine kinase inhibitors

genetic testing

gefitinib

crizotinib

personalized oncology