NoneSmall Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment Narjust Duma, MD; Rafael Santana-Davila, MD; and Julian R. Molina, MD, PhD CME Activity Target Audience: The target audience for Mayo Clinic Proceedings is primar- ily internal medicine physicians and other clinicians who wish to advance their current knowledge of clinical medicine and who wish to stay abreast of advances in medical research. Statement of Need: General internists and primary care physicians must maintain an extensive knowledge base on a wide variety of topics covering all body systems as well as common and uncommon disorders. Mayo Clinic Proceedings aims to leverage the expertise of its authors to help physicians understand best practices in diagnosis and management of conditions encountered in the clinical setting. Accreditation: In support of improving patient care, Mayo Clinic College of Medicine and Science is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Coun- cil for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the health care team. Credit Statements: Mayo Clinic College of Medicine and Science designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s).ä Physicians should claim only the credit commensurate with the extent of their participation in the activity. MOC Credit Statement: Successful completion of this CME activity, which in- cludes participation in the evaluation component, enables the participant to earn up to 1 MOC point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Learning Objectives: On completion of this article, you should be able to (1) identify risk factors for nonesmall cell lung cancer (NSCLC); (2) compare epidermal growth factor receptor inhibitors as first- and second-line therapy and their commonly seen adverse events in patients with NSCLC; (3) recog- nize the benefits and risks of immune checkpoint inhibitors in the treatment of advanced NSCLC; (4) assess special considerations for patients with brain metastasis and autoimmune disorders before receiving immune checkpoint inhibitors for the treatment of advanced/metastatic NSCLC; and (5) summa- rize systemic therapies available for patients with metastatic NSCLC. Disclosures: As a provider accredited by ACCME, Mayo Clinic College of Medicine and Science (Mayo School of Continuous Professional Develop- ment) must ensure balance, independence, objectivity, and scientific rigor in its educational activities. Course Director(s), Planning Committee mem- bers, Faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial rela- tionships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty also will disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of this information will be published in course materials so that those partic- ipants in the activity may formulate their own judgments regarding the pre- sentation. In their editorial and administrative roles, Karl A. Nath, MBChB, Terry L. Jopke, Kimberly D. Sankey, and Jenna Pederson, have control of the content of this program but have no relevant financial relationship(s) with industry. Dr Santana-Davila has received grant support from Abbvie, Merck, Pfizer, Bristol-Myers Squibb, F. Hoffmann-La Roche Ltd, Stemcentrx, Inc., Beyond- Spring Pharmaceuticals, Dynavax Technologies, ALX Oncology, AstraZeneca, and ISA Pharmaceuticals, and honoraria from Pharmamar. Bayer, Bristol-Myers Squibb, Lilly, and Genentech. Method of Participation: In order to claim credit, participants must com- plete the following: 1. Read the activity. 2. Complete the online CME Test and Evaluation. Participants must achieve a score of 80% on the CME Test. One retake is allowed. Visit www.mayoclinicproceedings.org, select CME, and then select CME arti- cles to locate this article online to access the online process. On successful completion of the online test and evaluation, you can instantly download and print your certificate of credit. Estimated Time: The estimated time to complete each article is approxi- mately 1 hour. Hardware/Software: PC or MAC with Internet access. Date of Release: 8/1/2019 Expiration Date: 7/31/2021 (Credit can no longer be offered after it has passed the expiration date.) Privacy Policy: http://www.mayoclinic.org/global/privacy.html Questions? Contact [email protected]. Abstract Lung cancer remains the leading cause of cancer deaths in the United States. In the past decade, sig- nificant advances have been made in the science of nonesmall cell lung cancer (NSCLC). Screening has been introduced with the goal of early detection. The National Lung Screening Trial found a lung cancer mortality benefit of 20% and a 6.7% decrease in all-cause mortality with the use of low-dose chest computed tomography in high-risk individuals. The treatment of lung cancer has also evolved with the introduction of several lines of tyrosine kinase inhibitors in patients with EGFR, ALK, ROS1, and NTRK mutations. Similarly, immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Furthermore, the results of new trials continue to help us understand the role of these novel agents and which patients are more likely to benefit; ICIs are now part of the first-line NSCLC treatment armamentarium as monotherapy, combined with chemotherapy, or after definite chemo- radiotherapy in patients with stage III unresectable NSCLC. Expression of programmed cell death protein-ligand 1 in malignant cells has been studied as a potential biomarker for response to ICIs. However, important drawbacks exist that limit its discriminatory potential. Identification of accurate From the Division of Medical Oncology, Mayo Clinic, Rochester, MN (N.D., J.R.M.); and Division of Medical Oncology, Department of Medicine, University of Washington, Seattle (R.S.-D.). THEMATIC REVIEW ON NEOPLASTIC HEMATOLOGY AND MEDICAL ONCOLOGY Mayo Clin Proc. n August 2019;94(8):1623-1640 n https://doi.org/10.1016/j.mayocp.2019.01.013 www.mayoclinicproceedings.org n ª 2019 Mayo Foundation for Medical Education and Research 1623
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