From the Guidelines
Neoadjuvant therapy is recommended for select patients with localized squamous cell lung cancer, particularly those with stage III disease, as it may improve resectability and survival rates. The decision to give neoadjuvant therapy should be discussed at a multidisciplinary conference (MCC) and options include neoadjuvant chemotherapy or concurrent chemoradiotherapy 1.
Key Considerations
- Histologic confirmation of diagnosis is recommended before any therapy 1.
- Cisplatin-based combination chemotherapy is a reasonable option for neoadjuvant therapy, although the optimal regimen is not yet established 1.
- Neoadjuvant therapy aims to downstage tumors, eliminate micrometastases, and improve resectability, potentially converting initially unresectable disease to resectable status.
Treatment Approach
- A common regimen is cisplatin 75 mg/m² plus gemcitabine 1250 mg/m² on days 1 and 8 every 3 weeks for 3-4 cycles before surgery.
- For patients with PD-L1 expression ≥1%, adding immunotherapy such as nivolumab (360 mg every 3 weeks) or pembrolizumab (200 mg every 3 weeks) to chemotherapy has shown improved pathological complete response rates.
- Chemoradiation may be considered for superior sulcus tumors or bulky N2 disease, typically delivering 45-54 Gy of radiation concurrently with weekly carboplatin (AUC 2) and paclitaxel (45 mg/m²).
Assessment and Surgery
- Treatment response should be assessed after completion using CT imaging, with surgery typically performed 4-6 weeks after chemotherapy or 4-8 weeks after chemoradiation to allow for recovery while maintaining treatment efficacy.
- The role of neoadjuvant therapy in the treatment of localized squamous cell carcinoma (SCC) of the lung is supported by studies such as the third CECCOG consensus on the systemic treatment of non-small-cell lung cancer, which suggests that neoadjuvant chemotherapy may be considered in stage III disease 1.
From the Research
Neoadjuvant Therapy in Localized Squamous Cell Carcinoma (SCC) of the Lung
- The role of neoadjuvant therapy in the treatment of localized squamous cell carcinoma (SCC) of the lung is being explored in various studies 2, 3, 4, 5, 6.
- Neoadjuvant chemotherapy with docetaxel has shown promising results in stage IIIA and IIIB non-small cell lung cancer patients, with an encouraging trend towards longer median survival 3.
- The combination of docetaxel, gemcitabine, and cisplatin has been effective in treating recurrent non-small-cell lung carcinoma, even in patients who have failed to respond to more than one chemotherapy regimen 2.
- Neoadjuvant immunotherapy combined with chemotherapy has also shown feasibility and efficacy in local advanced NSCLC, with significant tumor shrinkage and improved outcomes 4, 5.
- A study comparing neoadjuvant PD-1 inhibitor combined with chemotherapy versus neoadjuvant chemotherapy in resectable squamous cell carcinoma of the lung found that the combination of PD-1 blockade and chemotherapy increased the pathological complete response rate and major pathological response rate 6.
Key Findings
- Neoadjuvant therapy can be effective in treating localized SCC of the lung, with various combinations of chemotherapy and immunotherapy being explored.
- Docetaxel-based neoadjuvant chemotherapy has shown promising results in advanced non-small cell lung cancer patients 3.
- Immunotherapy combined with chemotherapy has shown feasibility and efficacy in local advanced NSCLC, with significant tumor shrinkage and improved outcomes 4, 5.
- The combination of PD-1 blockade and chemotherapy may indicate an increased major pathological response and pathological complete response rate in resectable squamous cell carcinoma of the lung 6.
Treatment Options
- Neoadjuvant chemotherapy with docetaxel, gemcitabine, and cisplatin may be considered for patients with recurrent non-small-cell lung carcinoma 2.
- Neoadjuvant immunotherapy combined with chemotherapy may be considered for patients with local advanced NSCLC 4, 5.
- The combination of PD-1 blockade and chemotherapy may be considered for patients with resectable squamous cell carcinoma of the lung 6.