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Editorial |

Non–Small Cell Lung Cancer and Precision Medicine:  A Model for the Incorporation of Genomic Features Into Clinical Trial Design

Boris Pasche, MD, PhD1,2; Stefan C. Grant, MD, JD, MBA3
[+] Author Affiliations
1Department of Cancer Biology and Comprehensive Cancer Center, Wake Forest University, Winston Salem, North Carolina
2Associate Editor, JAMA
3Division of Hematology/Oncology, Department of Medicine, The University of Alabama at Birmingham
JAMA. 2014;311(19):1975-1976. doi:10.1001/jama.2014.3742.
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Lung cancer remains the leading cause of cancer death in the United States. It is estimated that 228 190 patients were diagnosed with the disease and 159 480 died of lung cancer in 2013.1 Historically, lung cancer has been categorized, based on histology, into non–small cell lung cancer (NSCLC) constituting approximately 85% of cases and small cell lung cancer accounting for approximately 15% of the cases. Treatment for advanced NSCLC has been associated with relatively low response rates and significant toxicity, and only in the last 20 years has an agreement been reached that chemotherapy for this disease confers a survival benefit.2 At the same time, no distinction was made in treatment between the various subtypes of NSCLC3 until 2008 when a randomized trial demonstrated differences in response rates to specific chemotherapy regimens between squamous and nonsquamous lung carcinomas.4Addition of the antiangiogenic agent bevacizumab resulted in a 2-month improvement in median survival in patients with nonsquamous cell lung cancer.4 However, a subsequent study suggested that the benefit of this therapy may be limited to patients 65 years or younger.5

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