What is squamous cell lung carcinoma?

From the Guidelines

Squamous cell lung carcinoma treatment should prioritize a multimodal approach, including surgical resection, chemotherapy, radiation, and immunotherapy, with consideration of the patient's performance status, age, and tumor characteristics, as outlined in the most recent guidelines and studies 1, 2.

Treatment Approach

The treatment of squamous cell lung carcinoma (SqCLC) depends on the stage at diagnosis. For early-stage disease, surgical resection is the primary treatment, with lobectomy (removal of a lung lobe) and mediastinal lymph node sampling being the standard approach.

• In stages I-II, adjuvant chemotherapy with a platinum-based regimen may be recommended after surgery, particularly for tumors larger than 4 cm or with lymph node involvement.
• For locally advanced disease (stage III), a multimodality approach combining chemotherapy, radiation, and possibly surgery is often used.
• In metastatic disease (stage IV), systemic therapy is the mainstay, with options including platinum-based chemotherapy, immunotherapy (pembrolizumab, nivolumab, or atezolizumab), or targeted therapy if specific genetic alterations are present.

Immunotherapy and Targeted Therapy

PD-L1 testing is important as high expression may indicate a better response to immunotherapy. Squamous lung cancer typically lacks driver mutations common in adenocarcinoma, but testing for alterations in EGFR, ALK, ROS1, and BRAF should still be performed.

• Immunotherapy agents such as nivolumab, pembrolizumab, and atezolizumab have shown survival benefits in advanced SqCLC, and their use should be considered based on patient eligibility and PD-L1 expression status 2.
• Targeted therapy should be pursued in patients with specific genetic alterations, such as EGFR mutations.

Patient Factors

Treatment choices should also consider patient factors, including performance status, age, and comorbidities.

• For patients with poor performance status, treatment options may be limited, and best supportive care may be the primary focus.
• Smoking cessation is crucial for all patients, as it improves treatment outcomes and reduces the risk of second primary cancers.

Recent Guidelines and Studies

Recent studies and guidelines have outlined the current and emergent therapy options for advanced SqCLC, including the use of necitumumab, afatinib, nivolumab, pembrolizumab, and atezolizumab 1, 2, 3.

• These studies have shown that a multimodal approach, including surgical resection, chemotherapy, radiation, and immunotherapy, can improve treatment outcomes for patients with SqCLC.
• The treatment algorithm for advanced SqCLC should be individualized based on patient characteristics, tumor features, and treatment eligibility.

From the Research

Squamous Lung Carcinoma Overview

• Squamous cell carcinoma (SCC) of the lung is a type of non-small-cell lung cancer (NSCLC) that is usually linked with smoking 4, 5.
• It can be difficult to treat because it is often diagnosed after it has spread to other parts of the body 4.

Treatment Options

• Most patients receive a combination of chemotherapy and immunotherapy as their first-line treatment 4.
• Immunotherapy drugs have improved how long people with SCC of the lung can live for, but they eventually stop working for most patients 4.
• Second-line treatment options are considered after the first-line treatment is stopped due to side effects or because it no longer works 4, 5.
• Available second-line options include afatinib, docetaxel with or without ramucirumab, and other potential treatments that are being developed 4, 5.

Prognostic Factors

• Age and interstitial lung abnormalities (ILAs) are associated with poor overall survival (OS) and disease-free survival (DFS) in patients with SCC of the lung 6.
• CT-determined ILAs are a strong biomarker predicting poor outcome 6.
• Prognosis may not vary according to tumor location, but central and peripheral tumors exhibit different recurrence patterns 6.

Diagnostic Methods

• Computed tomography (CT) scan is an economical, effective, noninvasive, commonly available, and quick diagnostic way for lung cancer 7.
• CT characteristics, including lesion size and shape, single/multifocal lesions, location of the tumor, and margin of lobes, can help distinguish lung adenocarcinoma from SCC 7.