Diagnosis and first-line treatment of non-small cell lung cancer in the era of novel immunotherapy: recommendations for clinical practice.

In the era of personalized cancer therapy, the sampling of adequate tumor tissue for histologic diagnosis and genomic profiling is crucial, not only at the initial diagnosis but also in the event of resistant and recurrent disease when sequential biopsies may be required to evaluate somatic mutations and histologic changes. Areas covered: The identification of genetic driver alterations led to the selection of patients who are most likely to benefit from epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) and rat osteosarcoma (ROS-1) tyrosine kinase inhibitors; on the other hand, in the absence of oncogenic alterations, platinum-based doublet chemotherapy regimens were the cornerstone of treatment. However, the advent of immunotherapy has widely changed the first-line treatment. Expert commentary: An Italian Experts Panel Meeting was held to discuss on recommendations for diagnosis (optimization of the cyto/histologic tumor sample issue and management of tissue to molecular evaluation) and immunotherapy as first-line treatment of patients with advanced non-small-cell lung cancer.