Biomarkers, Prediction, and Prognosis in Non-Small-Cell Lung Cancer: A Platform for Personalized Treatment

In lung cancer, the introduction of targeted agents in those patients who carry a genetic abnormality has resulted in better clinical outcomes with better quality of life. These molecular abnormalities have also become predictive biomarkers. It is imperative that we continue searching for these biomarkers in different tumorigenesis pathways, so we can provide the most appropriate therapy to each individual in the near future. Since the 1980s, chemotherapy for patients with advanced non-small-cell lung cancer has been shown to provide a small improvement in survival. In the early 1990s, platinum-based regimens became the backbone of treatment for this disease. In 2002, the Eastern Cooperative Oncology Group 1594 clinical trial showed that there was no overall survival difference among four common chemotherapy regimens used in non-small-cell lung cancer. It was not until 2006 when the introduction of biologic agents into the field of lung cancer improved, for the first time ever, median overall survival beyond 1 year. To date, we recognize that there are differences between all histologic subtypes of non-small-cell lung cancer in terms of their response to specific agents. All these plus the introduction of molecular medicine have resulted in the identification of markers for prognosis and prediction in lung cancer. In this review, we describe the actual and ongoing clinical efforts to validate the prognostic and predictive value of these potential markers in lung cancer. We hope that the clinical use of biomarkers will help us to deliver personalized medicine to our lung cancer patients by improving their quality of response which may translate into further survival advantage.