What are the treatment options for lung cancer management?

From the Guidelines

Lung cancer treatment should prioritize a multimodal approach, combining surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy, with the most recent and highest quality study suggesting that platinum-based chemotherapy prolongs survival, improves symptom control, and yields superior quality of life compared to best supportive care 1.

Treatment Options

• Surgery (lobectomy, pneumonectomy, or wedge resection) is preferred for early-stage non-small cell lung cancer (NSCLC)
• Radiation therapy may be used alone or with other treatments, with stereotactic body radiation therapy (SBRT) offering precise treatment for small tumors
• Chemotherapy regimens often include platinum-based drugs like cisplatin or carboplatin combined with agents such as paclitaxel, docetaxel, gemcitabine, or pemetrexed
• Targeted therapies address specific genetic mutations: EGFR inhibitors (osimertinib, erlotinib), ALK inhibitors (alectinib, brigatinib), ROS1 inhibitors (entrectinib, crizotinib), and BRAF inhibitors (dabrafenib with trametinib)
• Immunotherapies like pembrolizumab, nivolumab, and atezolizumab help the immune system fight cancer cells

Patient Factors

• Performance status (PS) and age are important factors in selecting systemic therapy
• Unfit patients of any age (PS 3-4) do not benefit from cytotoxic treatment, except erlotinib for those who are EGFR mutation-positive 1

Recent Developments

• The last decade has seen a considerable change in the field of systemic treatment, with the molecular characterization of lung cancer leading to the approval of targeted therapies that improve PFS, response rate, and QoL in small subsets of patients 1
• The benefits of second-line single-agent drugs (pemetrexed, docetaxel, or EGFR-TKI) have also been validated 1

From the FDA Drug Label

Non-Small Cell Lung Cancer (NSCLC) in combination with pemetrexed and platinum chemotherapy, as first-line treatment of patients with metastatic nonsquamous NSCLC, with no EGFR or ALK genomic tumor aberrations. (1.2) in combination with carboplatin and either paclitaxel or paclitaxel protein-bound, as first-line treatment of patients with metastatic squamous NSCLC. (1. 2) as a single agent for the first-line treatment of patients with NSCLC expressing PD-L1 [Tumor Proportion Score (TPS) ≥1%] as determined by an FDA-approved test, with no EGFR or ALK genomic tumor aberrations, and is: Stage III where patients are not candidates for surgical resection or definitive chemoradiation, or metastatic. (1.2. 1) as a single agent for the treatment of patients with metastatic NSCLC whose tumors express PD-L1 (TPS ≥1%) as determined by an FDA-approved test, with disease progression on or after platinum-containing chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving KEYTRUDA. (1.2. 1) for the treatment of patients with resectable (tumors ≥4 cm or node positive) NSCLC in combination with platinum-containing chemotherapy as neoadjuvant treatment, and then continued as a single agent as adjuvant treatment after surgery. (1. 2) as a single agent, for adjuvant treatment following resection and platinum-based chemotherapy for adult patients with Stage IB (T2a ≥4 cm), II, or IIIA NSCLC. (1.2) Docetaxel Injection as a single agent is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of prior platinum-based chemotherapy Docetaxel Injection in combination with cisplatin is indicated for the treatment of patients with unresectable, locally advanced or metastatic non-small cell lung cancer who have not previously received chemotherapy for this condition.

The treatment options for lung cancer management include:

• Combination therapy: pembrolizumab in combination with pemetrexed and platinum chemotherapy, or carboplatin and either paclitaxel or paclitaxel protein-bound, as first-line treatment for metastatic NSCLC.
• Single agent therapy: pembrolizumab as a single agent for the first-line treatment of patients with NSCLC expressing PD-L1, or as a single agent for the treatment of patients with metastatic NSCLC whose tumors express PD-L1 with disease progression on or after platinum-containing chemotherapy.
• Neoadjuvant and adjuvant treatment: pembrolizumab in combination with platinum-containing chemotherapy as neoadjuvant treatment, and then continued as a single agent as adjuvant treatment after surgery.
• Adjuvant treatment: pembrolizumab as a single agent, for adjuvant treatment following resection and platinum-based chemotherapy for adult patients with Stage IB, II, or IIIA NSCLC.
• Docetaxel Injection: as a single agent for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of prior platinum-based chemotherapy, or in combination with cisplatin for the treatment of patients with unresectable, locally advanced or metastatic non-small cell lung cancer who have not previously received chemotherapy for this condition 2, 3.

From the Research

Treatment Options for Lung Cancer Management

The treatment options for lung cancer management include:

• Chemotherapy: Platinum-based chemotherapy is considered standard treatment for advanced non-small-cell lung cancer (NSCLC) 4, 5
• Combination therapy: Combination regimens such as topotecan and vinorelbine have shown promising activity against NSCLC with a favorable toxicity profile 4
• Adjuvant chemotherapy: Adjuvant chemotherapy has been proven to be beneficial for patients with early stage non-small cell lung cancer 6
• Immunotherapy: Pembrolizumab plus chemotherapy has been shown to significantly prolong overall survival among patients with metastatic, squamous NSCLC 7
• Targeted therapy: Gemcitabine and carboplatin in combination is a convenient and well-tolerated treatment option for advanced, metastatic, non-small cell lung cancer 8

Chemotherapy Regimens

Some common chemotherapy regimens for lung cancer management include:

• Cisplatin and vinorelbine: A standard adjuvant regimen for early stage non-small cell lung cancer 6
• Pemetrexed and cisplatin: A well-tolerated and effective regimen for advanced non-small cell lung cancer 6
• Carboplatin and paclitaxel: A commonly used regimen for metastatic, squamous NSCLC 7
• Gemcitabine and carboplatin: A convenient and well-tolerated regimen for advanced, metastatic, non-small cell lung cancer 8

Immunotherapy and Targeted Therapy

Immunotherapy and targeted therapy are also important treatment options for lung cancer management:

• Pembrolizumab: An immunotherapy agent that has been shown to significantly prolong overall survival among patients with metastatic, squamous NSCLC 7
• Gemcitabine: A targeted therapy agent that has been shown to be effective in combination with carboplatin for advanced, metastatic, non-small cell lung cancer 8