What are the treatment options for Lung Squamous Cell Carcinoma?

From the Guidelines

Treatment options for Lung Squamous Cell Carcinoma should prioritize a multimodal approach, including surgical resection, chemotherapy, radiation therapy, and immunotherapy, with consideration of the patient's performance status, comorbidities, and preferences, as supported by recent studies 1.

Overview of Treatment Options

The treatment of Lung Squamous Cell Carcinoma (SqCLC) depends on the stage of the disease and the patient's overall health. For early-stage disease, surgical resection is the primary treatment, which may be followed by adjuvant chemotherapy. In locally advanced disease, a multimodal approach combining chemotherapy, radiation therapy, and possibly surgery is typically used. For metastatic disease, systemic therapy, including immunotherapy with PD-1/PD-L1 inhibitors, is the mainstay of treatment.

Early-Stage Disease (Stages I and II)

• Surgical resection is the primary treatment, involving removal of the tumor and surrounding tissue through procedures like lobectomy or pneumonectomy.
• Adjuvant chemotherapy using platinum-based combinations, such as cisplatin with gemcitabine or carboplatin with paclitaxel, for 4 cycles may be considered.

Locally Advanced Disease (Stage III)

• A multimodal approach is used, combining chemotherapy, radiation therapy, and possibly surgery.
• Concurrent chemoradiation is common, with cisplatin-based chemotherapy given alongside radiation therapy for 6-7 weeks.

Metastatic Disease (Stage IV)

• Systemic therapy is the mainstay, including immunotherapy with PD-1/PD-L1 inhibitors like pembrolizumab (200mg IV every 3 weeks) or nivolumab (240mg IV every 2 weeks) 1.
• Chemotherapy combinations, such as carboplatin (AUC 6) plus paclitaxel (200mg/m²) every 3 weeks for 4-6 cycles, are also used.
• Targeted therapies may be considered for patients with specific genetic alterations, though these are less common in squamous cell carcinoma than in adenocarcinoma.

Palliative Care

• Palliative care, including management of symptoms like pain, dyspnea, and cough, is essential throughout treatment to maintain quality of life.
• Treatment decisions should be made by a multidisciplinary team considering the patient's performance status, comorbidities, and preferences, as recommended by recent guidelines 1.

Recent Studies and Guidelines

Recent studies, such as those published in the Journal of Thoracic Oncology 1, and guidelines from the National Comprehensive Cancer Network 1, support the use of a multimodal approach in the treatment of Lung Squamous Cell Carcinoma, with consideration of the patient's performance status, comorbidities, and preferences.

From the FDA Drug Label

KEYTRUDA may be used with the chemotherapy medicines carboplatin and either paclitaxel or paclitaxel protein-bound as your first treatment when your lung cancer: has spread (advanced NSCLC), and is a type called “squamous” KEYTRUDA may be used alone as your first treatment when your lung cancer: has not spread outside your chest (Stage III) and you cannot have surgery or chemotherapy with radiation or your NSCLC has spread to other areas of your body (advanced NSCLC), and your tumor tests positive for “PD-L1”, and does not have an abnormal “EGFR” or “ALK” gene

The treatment options for Lung Squamous Cell Carcinoma include:

• Combination therapy: KEYTRUDA with carboplatin and either paclitaxel or paclitaxel protein-bound as first-line treatment for advanced NSCLC with squamous histology.
• Monotherapy: KEYTRUDA alone as first-line treatment for advanced NSCLC with squamous histology, if the tumor tests positive for PD-L1 and does not have an abnormal EGFR or ALK gene. 2

From the Research

Treatment Options for Lung Squamous Cell Carcinoma

• The primary treatment for Lung Squamous Cell Carcinoma (SCC) often involves a combination of chemotherapy and immunotherapy as the first-line treatment 3.
• Immunotherapy drugs have been shown to improve the survival rate of patients with SCC of the lung, but they eventually stop working, leading to the need for second-line treatments 3, 4.
• Second-line treatment options include afatinib, which is taken as a tablet, and docetaxel with or without ramucirumab, given as an infusion 3, 5.
• Other potential treatments are being developed, with some early clinical trials showing promise, but more results are needed 3, 6.
• Research into the genetic mutations linked to the development of SCC of the lung is ongoing, with the goal of identifying patients who may benefit from specific treatments 3, 5.

Role of Immunotherapy

• Immunotherapy, including programmed death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibition, has shown potential in treating advanced squamous cell lung cancer 4, 6.
• Nivolumab, a PD-1 immune checkpoint inhibitor, has been approved by the US Food and Drug Administration (FDA) for the treatment of squamous cell NSCLC in the second-line setting 4.
• Pembrolizumab, given alone or in combination with platinum-based chemotherapy, is now a standard first-line treatment for squamous cell lung cancer 7.

Emerging Treatments

• Afatinib, an irreversible ErbB family blocker, has shown potential as a second or subsequent therapy for some patients with squamous cell lung carcinoma 5, 7.
• The Phase III LUX-Lung 8 study demonstrated that afatinib significantly prolonged progression-free and overall survival compared to erlotinib in patients with squamous cell lung carcinoma 7.
• Further data are required to support the use of afatinib following immunotherapy, but it could be considered as a potential second-line treatment option for patients who have progressed on combined pembrolizumab and platinum-based chemotherapy 7.