Precision medicine has sharpened the focus on combination therapy. Instead of a one-size-fits-all approach, treatment is increasingly tailored to the biological features of each person’s tumor.
That process begins with a biopsy. A pathologist first determines whether the cancer is small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC), which is more common. NSCLC includes several subtypes, such as adenocarcinoma, the most common form.
For many people with NSCLC, the next step is extensive molecular testing. Doctors look for “driver mutations”—specific genetic changes that fuel tumor growth.
“We look at the genes, the DNA of the cancer, and what drives the cancer to grow,” Dr. Goldberg says. “There are many possible genetic alterations that could be telling the cells to grow abnormally, to change and spread, which wouldn’t happen in normal cells.”
That information helps determine whether targeted therapy alone—or in combination with chemotherapy or another drug—may be appropriate.
“We personalize treatment based on that information, and on other medical issues they might have and their wishes as far as treatment,” Dr. Goldberg says.
Some patients with advanced cancer who are frail from other health conditions may prioritize treatments that extend life as long as possible. Others may focus more on maintaining quality of life.
“Everyone is different,” she says.
