Management of Patients with Advanced Non-Small Cell Lung Cancer

Significant progress has been made in the treatment of NSCLC, with the ability to identify patients who have actionable mutations, such as EGFR, ALK, ROS1, and BRAF.

However, only a small percentage of patients have actionable mutations. What are the best strategies for treating these patients?

Well, first of all medical staff of the clinical site should discuss treatment options for the majority of patients with NSCLC, not only for those who have actionable mutations but also for those who are not candidates for targeted therapy –including therapies for patients who have progression on a platinum doublet-.

Some recommendations for First-Line Treatment of NSCLC are the following:

  • Targeted therapy (not chemotherapy or immunotherapy) for patients with EGFR, ALK, or ROS1 mutations.
  • Immunotherapy for patients with PD-L1 expression ≥50%.
  • Chemotherapy for patients with squamous cell histology, no actionable mutations, and no or low PD-L1.
  • Nab-paclitaxel or gemcitabine for those with squamous cell histology.
    • Pemetrexed for those with nonsquamous cell histology.
    • First-line pembrolizumab/carboplatin/pemetrexed for patients with advanced nonsquamous NSCLC or NSCLC NOS.
    • Bevacizumab may be appropriate for select patients who have nonsquamous NSCLC with no actionable mutations.

Once the medical staff have discussed the options, they must have the ability to communicate effectively with patients and caregivers about their therapeutic options.

Some factors have to be considered when choosing between doublet and triplet regimens, for example: carboplatin and pemetrexed are generally well tolerated, but are not likely to yield durable responses; or the fact that pembrolizumab is generally well tolerated but has potential toxicities, such as colitis, fatigue, and less commonly, pneumonitis.

This is why it is very important to train study nurses in the management of treatment-related AEs in the setting of NSCLC. Some common adverse events the patients could have are: dermatologic toxicity, rash, diarrhea, colitis, hypophysitis, hypothyroidism, elevated AST and ALT levels and hepatitis, some other less common AEs could be: pneumonitis, pancreatitis, neurologic toxicity, renal toxicity, ophthalmologic toxicity or cardiotoxicity.

At Althian, we have highly trained staff in management of patients with advanced NSCLC. If you are looking to run a trial with a treatment option for this kind of patients, don’t hesitate in contacting us and we will be pleased to help you.