What are the treatment options for lung cancer?

From the Guidelines

Lung cancer treatment should prioritize a multidisciplinary approach, incorporating surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy, tailored to the individual patient's cancer stage, type, and molecular profile, as well as their overall health status, with a focus on minimizing morbidity, mortality, and improving quality of life. When considering treatment options for lung cancer, it is essential to take into account the specific histology and molecular characteristics of the tumor, as well as the patient's performance status and age 1. For example, in patients with advanced squamous cell lung cancer, treatment options may include combination chemotherapy regimens such as carboplatin plus paclitaxel, alongside immunotherapy drugs like pembrolizumab (Keytruda) or nivolumab (Opdivo) 1. In contrast, patients with specific genetic mutations, such as EGFR mutations, may benefit from targeted therapies like osimertinib, which has been shown to be effective in treating EGFR-mutant non-small cell lung cancer 1. Additionally, small cell lung cancer typically requires aggressive chemotherapy with cisplatin or carboplatin plus etoposide, often combined with radiation therapy. Some key points to consider in lung cancer treatment include:

• The importance of molecular testing to identify specific genetic mutations and guide treatment decisions
• The role of immunotherapy in treating advanced lung cancer, particularly in patients with high PD-L1 expression
• The need for regular follow-up imaging and assessments to monitor treatment response and adjust therapy as needed
• The importance of side effect management, including supportive medications for nausea, pain control, and immune-related adverse events
• The consideration of patient's overall health status, performance status, and age in treatment decision-making. Overall, a personalized and multidisciplinary approach to lung cancer treatment is crucial to optimizing outcomes and improving quality of life for patients with this disease.

From the FDA Drug Label

INDICATIONS AND USAGE KEYTRUDA is a programmed death receptor-1 (PD-1)-blocking antibody indicated: 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. in combination with carboplatin and either paclitaxel or paclitaxel protein-bound, as first-line treatment of patients with metastatic squamous NSCLC. 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. 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. 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. 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.

INDICATIONS AND USAGE OPDIVO is a programmed death receptor-1 (PD-1)-blocking antibody indicated for the treatment of: Non-Small Cell Lung Cancer (NSCLC) adult patients with resectable (tumors ≥4 cm or node positive) non-small cell lung cancer in the neoadjuvant setting, in combination with platinum-doublet chemotherapy. adult patients with resectable (tumors ≥4 cm or node positive) non-small cell lung cancer and no known EGFR mutations or ALK rearrangements, for neoadjuvant treatment, in combination with platinum-doublet chemotherapy, followed by single-agent OPDIVO as adjuvant treatment after surgery. adult patients with metastatic non-small cell lung cancer expressing PD‑L1 (≥1%) as determined by an FDA-approved test, with no EGFR or ALK genomic tumor aberrations, as first-line treatment in combination with ipilimumab. adult patients with metastatic or recurrent non-small cell lung cancer with no EGFR or ALK genomic tumor aberrations as first-line treatment, in combination with ipilimumab and 2 cycles of platinum-doublet chemotherapy. adult patients with metastatic non-small cell lung cancer and progression on or after platinum-based chemotherapy.

Lung Cancer Treatment Options:

• Pembrolizumab (KEYTRUDA):
  • First-line treatment for metastatic nonsquamous NSCLC with no EGFR or ALK genomic tumor aberrations, in combination with pemetrexed and platinum chemotherapy.
  • First-line treatment for metastatic squamous NSCLC, in combination with carboplatin and either paclitaxel or paclitaxel protein-bound.
  • First-line treatment for NSCLC expressing PD-L1 (TPS ≥1%) with no EGFR or ALK genomic tumor aberrations.
  • Treatment for metastatic NSCLC with disease progression on or after platinum-containing chemotherapy.
• Nivolumab (OPDIVO):
  • Neoadjuvant treatment for resectable NSCLC, in combination with platinum-doublet chemotherapy.
  • First-line treatment for metastatic NSCLC expressing PD-L1 (≥1%) with no EGFR or ALK genomic tumor aberrations, in combination with ipilimumab.
  • First-line treatment for metastatic or recurrent NSCLC with no EGFR or ALK genomic tumor aberrations, in combination with ipilimumab and 2 cycles of platinum-doublet chemotherapy.
  • Treatment for metastatic NSCLC with progression on or after platinum-based chemotherapy. 2 3

From the Research

Lung Cancer Treatment Options

• Treatment options for lung cancer include surgery, radiation therapy, chemotherapy, and targeted therapy 4, 5, 6.
• The choice of treatment depends on several factors, including the type and stage of cancer 4, 5, 6.
• Non-small cell lung cancer (NSCLC) is typically treated with surgery for early-stage disease, while advanced NSCLC is treated with a multimodality approach that may include radiotherapy, chemotherapy, and palliative care 5, 6.
• Small cell lung cancer is usually treated with chemotherapy, often in combination with radiotherapy 5, 7.

Diagnostic Evaluation

• The diagnostic evaluation of patients with suspected lung cancer includes tissue diagnosis, a complete staging work-up, and a functional patient evaluation 5, 6.
• Histologic diagnosis may be obtained through various methods, including sputum cytology, thoracentesis, and bronchoscopy 5, 6.
• Imaging tests such as chest computed tomography and positron emission tomography are also used to evaluate the extent of disease 5, 6.

Recent Advances in Treatment

• Immunotherapy has emerged as a promising treatment option for advanced lung cancer, providing durable responses in some patients 7, 8.
• However, resistance to immunotherapy can occur, and small cell transformation of NSCLC is a recognized mechanism of resistance 7.
• Targeted therapies, such as those targeting EGFR mutations, have also improved treatment outcomes for patients with NSCLC 4, 8.
• Ongoing research aims to develop more effective and personalized treatment strategies for lung cancer, including the use of predictive clinical and genetic markers 8.