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Treatment Considerations for Patients With Advanced Squamous Cell Carcinoma of the Lung

Edgardo S Santos¹, Estelamari Rodriguez²

¹Florida Precision Oncology/A Division of Genesis Care USA, Florida Atlantic University, Aventura, FL.

Clinical Lung Cancer

|July 25, 2022

Abstract:

Squamous cell carcinoma (SCC) of the lung has a markedly different molecular profile to adenocarcinoma of the lung and remains difficult to treat because of the lack of targeted therapies for this type of non-small cell lung cancer (NSCLC). With immune checkpoint inhibitors moving from second-line treatment to first-line in NSCLC, effective second-line options following immunotherapy is an urgent unmet need. Appropriate treatment decisions are currently hindered by a lack of prospective clinical data. However, available real-world data suggest that ramucirumab plus docetaxel warrants prospective evaluation in this setting. Also, afatinib is approved in the second line in patients with SCC progressing on first-line platinum-based chemotherapy and may also be an option following immunochemotherapy combinations. Afatinib has the advantage of oral administration with a well-defined tolerability profile. Docetaxel, gemcitabine and platinum-based chemotherapy may be options for some patients, but overall, there are very few options for patients requiring second-line treatment after immunotherapy. This lack of options has prompted efforts to further define the molecular profile of lung SCC to match patients with relevant targeted therapies and to elucidate additional genomic targets. In order to ensure patients with SCC of the lung receive optimal treatment, genomic testing is essential to identify those patients who might benefit from existing targeted agents or clinical trials, and further prospective data are urgently required to assess potential second-line regimens following immunotherapy.

Insights

Effective second-line treatments for lung squamous cell carcinoma (SCC) after immunotherapy are urgently needed. Real-world data suggest ramucirumab plus docetaxel and oral afatinib warrant further investigation for this non-small cell lung cancer subtype.

Area of Science:

Oncology
Pulmonology
Cancer Genomics

Background:

Lung squamous cell carcinoma (SCC) has a distinct molecular profile compared to adenocarcinoma, presenting treatment challenges due to limited targeted therapies.
The increasing use of immune checkpoint inhibitors in non-small cell lung cancer (NSCLC) creates an urgent need for effective second-line treatments post-immunotherapy.
Current treatment decisions for advanced SCC are hampered by a scarcity of prospective clinical data.

Purpose of the Study:

To review available data and identify potential second-line treatment options for lung squamous cell carcinoma following immunotherapy.
To highlight the need for further research into targeted therapies and genomic targets for lung SCC.
To emphasize the importance of genomic testing for personalized treatment selection in lung SCC.

Main Methods:

Review of available real-world data and existing clinical approvals for second-line therapies in lung SCC.
Analysis of treatment options following immunotherapy and platinum-based chemotherapy.
Discussion of the role of molecular profiling and genomic testing in guiding treatment decisions.

Main Results:

Real-world data suggest ramucirumab plus docetaxel as a potential second-line regimen warranting prospective evaluation.
Afatinib is an approved second-line option for SCC progressing after first-line chemotherapy and may be considered post-immunochemotherapy.
Chemotherapy agents like docetaxel, gemcitabine, and platinum-based regimens may serve as options, but overall choices remain limited.

Conclusions:

There is a critical unmet need for effective second-line treatments for lung squamous cell carcinoma after immunotherapy.
Prospective data are essential to validate potential regimens like ramucirumab plus docetaxel and afatinib.
Genomic testing is crucial for identifying patients who could benefit from targeted therapies or clinical trials, optimizing SCC treatment.

Read full analysis

Keywords:

Afatinib Docetaxel NSCLC Ramucirumab Second line

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