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Table of Contents   
Year : 2017  |  Volume : 12  |  Issue : 4  |  Page : 219-220
Saudi lung cancer management guidelines 2017: Improving lung cancer care in Saudi region

1 Phase I-Early Clinical Trials Unit, Antwerp University Hospital and Center for Oncological Research, Edegem, Belgium
2 Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria

Date of Submission11-Jul-2017
Date of Acceptance16-Jul-2017
Date of Web Publication10-Oct-2017

Correspondence Address:
Christian Rolfo
Phase I-Early Clinical Trials Unit, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/atm.ATM_225_17

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How to cite this article:
Rolfo C, Zielinski CC. Saudi lung cancer management guidelines 2017: Improving lung cancer care in Saudi region. Ann Thorac Med 2017;12:219-20

How to cite this URL:
Rolfo C, Zielinski CC. Saudi lung cancer management guidelines 2017: Improving lung cancer care in Saudi region. Ann Thorac Med [serial online] 2017 [cited 2023 Feb 9];12:219-20. Available from:

Notwithstanding advancements in screening tests, genetic biology, diagnostic methods and targeted therapies, lung cancer remains a leading cause of death all over the world.[1] Nevertheless, first steps have been taken toward new treatment paradigms, and during last years, we have obtained promising results for our patients. It is very important to remember that this is a very complex disease that involves several medical disciplines; therefore, multidisciplinary teams must be involved to improve survivorship and quality of life in our patients.

The majority of our efforts must be done in the prevention and early diagnosis of this lethal disease. Recently, has been demonstrated that screening using a low-dose computed tomography scan can be recommended in high-risk patients, decreasing mortality rate by 20%.[2],[3] Improvements in radiotherapeutic techniques and surgical approaches are giving our patients the possibility of cure in early stage disease. But unfortunately, a big number of patients will develop metastases. Besides, the positive results of chemotherapy in this population, and the possibility to combine antiangiogenic drugs in second line, the therapeutic landscape has changed radically during the last decades. Especially the implementation of molecular targeted therapies in nonsmall cell lung cancer (NSCLC) harboring oncogenic drivers was an important step forward. The usual suspects epidermal growth factor receptor [4],[5],[6] and anaplastic lymphoma kinase,[7] are nowadays druggable markers with an important number of drugs approved in different scenarios, naïve, and pretreated patients. New drugs for targets such as BRAF, MET, and NTRK are arriving accelerating the approval process in an amazing way. The last entry in the pantheon of Lung Cancer treatment is Immunotherapy. Indeed, the development of checkpoint inhibitors, which modulate immune responses, have given rise to new compounds, which offer a new fighting mechanism for patients without oncogenic driver mutations. PD-1 and PD-L1 act as targetable checkpoints for different drugs such as nivolumab,[8],[9] pembrolizumab,[10] or atezolizumab.[11] Immunotherapy has been recently approved for the first line treatment.[12]

Unfortunately, small cell lung cancer is still refractory to the new treatment options, and only chemotherapy remains the current standard of care.

The new landscape of lung cancer treatment seems to be the combinatory strategy of immunotherapy with several compounds, chemotherapy, targeted therapies, and also immunotherapy. Langer et al.[13] presented hopeful results combining chemotherapy plus immunotherapy in NSCLC, and also several early trials involving immune checkpoints have been reported. Moreover, new strategies of personalized medicine based on molecular information and characterization of the tumor have an important impact in the diagnosis and targeted treatment. New concepts as liquid biopsy and Next-Generation Sequencing start to be used in our clinical practice, not only in diagnosis but also in monitoring responses and discovering resistance mechanisms.[14],[15]

Homogenization, multidisciplinary work, and scientific evidence based treatment are mandatory to integrate the biological knowledge and drug development. Guidelines are a necessary tool to treat our patients in the proper way. The authors of the current Saudi guidelines aims to collect latest evidence in the management of lung cancer in a trend to convert the complexity of scientific research into recommendations for using in everyday practice.[16] These guidelines provide an excellent compendium from first to later steps in lung cancer. Its principal function is to assist the physicians to make appropriate medical decisions. An extraordinary multidisciplinary effort was made to improve the quality of care of our patients in this part of the world.

   References Top

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Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB. Screening for lung cancer: Diagnosis and management of lung cancer, 3rd ed.: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143 5 Suppl:e78S-92S.  Back to cited text no. 2
National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.  Back to cited text no. 3
Rosell R, Carcereny E, Gervais R, Vergnenegre A, Massuti B, Felip E, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): A multicentre, open-label, randomised phase 3 trial. Lancet Oncol 2012;13:239-46.  Back to cited text no. 4
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Yang JC, Wu YL, Schuler M, Sebastian M, Popat S, Yamamoto N, et al. Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-lung 3 and LUX-lung 6): Analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol 2015;16:141-51.  Back to cited text no. 6
Solomon BJ, Mok T, Kim DW, Wu YL, Nakagawa K, Mekhail T, et al. First-line crizotinib versus chemotherapy in ALK-positive lung cancer. N Engl J Med 2014;371:2167-77.  Back to cited text no. 7
Brahmer J, Reckamp KL, Baas P, Crinò L, Eberhardt WE, Poddubskaya E, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med 2015;373:123-35.  Back to cited text no. 8
Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 2015;373:1627-39.  Back to cited text no. 9
Herbst RS, Baas P, Kim DW, Felip E, Pérez-Gracia JL, Han JY, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): A randomised controlled trial. Lancet 2016;387:1540-50.  Back to cited text no. 10
Rittmeyer A, Barlesi F, Waterkamp D, Park K, Ciardiello F, von Pawel J, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet. 2017 Jan 21;389(10066):255-265. doi: 10.1016/S0140-6736(16)32517-X. Epub 2016 Dec 13.  Back to cited text no. 11
Reck M, Rodríguez-Abreu D, Robinson AG, Hui R, Csőszi T, Fülöp A, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med 2016;375:1823-33.  Back to cited text no. 12
Langer CJ, Gadgeel SM, Borghaei H, Papadimitrakopoulou VA, Patnaik A, Powell SF, et al. Carboplatin and pemetrexed with or without pembrolizumab for advanced, non-squamous non-small-cell lung cancer: A randomised, phase 2 cohort of the open-label KEYNOTE-021 study. Lancet Oncol 2016;17:1497-508.  Back to cited text no. 13
Rolfo C, Castiglia M, Hong D, Alessandro R, Mertens I, Baggerman G, et al. Liquid biopsies in lung cancer: The new ambrosia of researchers. Biochim Biophys Acta 2014;1846:539-46.  Back to cited text no. 14
Sholl LM, Aisner DL, Allen TC, Beasley MB, Cagle PT, Capelozzi VL, et al. Liquid biopsy in lung cancer: A perspective from members of the pulmonary pathology society. Arch Pathol Lab Med 2016;140:825-9.  Back to cited text no. 15
Jazieh AR, AlKattan K, Bamousa A, AlOlayan A, Abdelwarith A, Ansari J, et al. Saudi lung cancer management guidelines 2017. Ann Thorac Med 2017;12:221-46.  Back to cited text no. 16
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