Non-Small Cell Lung Cancer

• Lung cancer is divided into two major types, small-cell (SCLC) and non-small cell lung cancer (NSCLC). NSCLC is the more common type and accounts for about 80 to 85 percent of lung cancer cases.¹
• Within NSCLC, there are subtypes of disease that start from different types of lung cells. These forms of lung cancer are often grouped together as NSCLC because treatment approaches are typically similar.¹

• The early stages of NSCLC do not typically cause symptoms.¹
• In later stages, lung cancer symptoms include:¹
• Persistent cough
• Sputum streaked with blood
• Chest pain
• Hoarseness
• Weight loss and loss of appetite
• Recurrent pneumonia or bronchitis
• Shortness of breath
• Feeling tired or weak
• New onset of wheezing

• Many cases of lung cancer can be linked to smoking, but other known risk factors for the disease include:¹
• Second-hand smoke
• Exposure to radon or asbestos
• Family history of lung cancer
• Approximately 10 percent of lung cancer cases occur in non-smokers.⁴

• Lung cancer is more prevalent in people over the age of 65, but younger people may be at risk due to genetic factors.¹
• The chance that a man will develop lung cancer in his lifetime is about 1 in 15, and about 1 in 17 for women.¹
• There are also differences in lung cancer incidence based on ethnicity. African-American men are about 20 percent more likely to develop lung cancer than white men.¹
• More than 30,000 Americans living with lung cancer have never smoked.¹¹

• If lung cancer is diagnosed at an early stage, individuals are three times as likely to live five years compared to a late-stage diagnosis.²
• If lung cancer spreads to other organs, five-year survival declines to five percent.⁴

• Certain molecular characteristics, or biomarkers, have been identified that can be detected by diagnostic tests to help guide treatment decisions. These biomarkers include, but are not limited to mutations in the: Epidermal Growth Factor Receptor (EGFR), which are found in 10-15 percent of NSCLC tumors; Anaplastic Lymphoma Kinase (ALK) fusion genes, which are found in approximately 3-5 percent of NSCLC tumors; c-ros oncogene 1 (ROS1), which are found in approximately 2 percent of NSCLC tumors; and Neurotrophic Tropomyosin Receptor Kinase (NTRK), which are found in approximately 3 percent of NSCLC tumors. In addition, many people have lung cancer with known protein biomarkers, such as PD-L1.^1,4,5,6,11

• People diagnosed with NSCLC should have their tumor tested to determine which treatment option is appropriate for them.^9,10
• Standard treatments for NSCLC may include the following:^1,2
• Surgery
• Radiofrequency ablation
• Radiation therapy
• Chemotherapy
• Targeted medicines
• Immunotherapy

¹ Lung Cancer (Non-Small Cell) Detailed Guide. American Cancer Society. Retrieved from: http://www.cancer.org/acs/groups/cid/documents/webcontent/003115-pdf.pdf.

² American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019.

³ Surveillance Epidemiology and End Results Stat Fact Sheets: Lung and Bronchus. National Cancer Institute. Retrieved from: http://seer.cancer.gov/statfacts/html/lungb.html.

⁴ Lung Cancer Risks For Non-Smokers. American Cancer Society. https://www.cancer.org/latest-news/why-lung-cancer-strikes-nonsmokers.html. Accessed August 8, 2018.

⁵ Pao W, Miller VA. Epidermal growth factor receptor mutations, small-molecule kinase inhibitors, and non-small-cell lung cancer: current knowledge and future directions. Journal of Clinical Oncology. 2005;23(11):2556-68.

⁶ Epidermal Growth Factor Receptor (EGFR) Testing for Advanced Non-Small Cell Lung Cancer. Cancer.net. Retrieved from: http://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/epidermal-growth-factor-receptor-egfr-testing-advanced-non-small-cell-lung-cancer.

⁷ Garber K. ALK, Lung Cancer, and Personalized Therapy: Portent of the Future? Journal of the National Cancer Institute. 2010;102:672-675.

⁸ Herbst RS, et al. Nature. 2014; 515:563-567.

⁹ NCCN Clinical Practice Guidelines in Oncology for Non-Small Cell Lung Cancer. National Comprehensive Cancer Network. Retrieved from: http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.

¹⁰ Keedy V, Termin S, Somerfield M, et al. American Society of Clinical Oncology Provisional Clinical Opinion: Epidermal Growth Factor Receptor (EGFR) Mutation Testing for Patients With Advanced Non–Small Cell Lung Cancer Considering First-Line EGFR Tyrosine Kinase Inhibitor Therapy. Journal of Clinical Oncology. 2011;29(15):2121-2127.

¹¹ Lung Cancer Risks For Non-Smokers. American Cancer Society. https://www.cancer.org/latest-news/why-lung- cancer-strikes-nonsmokers.html. Accessed August 8, 2018.

¹² Genetically Informed Cancer Medicine. My Cancer Genome. Retrieved from: https://www.mycancergenome.org/.