Multiple factors involved in selecting chemotherapy regimen for NSCLC
Various factors come into play when choosing the ideal chemotherapy regimen for non-small cell lung cancer (NSCLC), according to a presentation at the 21st Congress of the Asian Pacific Society of Respirology (APSR 2016) held in Bangkok, Thailand.
When selecting the best regimen, several factors must be considered including tumour factors (eg, histology and genomics), treatment factors (eg, efficacy, toxicity, side effects), clinical characteristics (eg, age, gender, performance status, comorbidities, smoking status), the patient’s preference or tolerance, and the treatment cost, availability, and accessibility, said Professor Sumitra Thongprasert from the Bangkok Hospital Chiang Mai in Chiang Mai, Thailand. [APSR 2016, Session 5A]
Not all cases of NSCLC should be treated in the same manner as different drugs potentially work better for different types of NSCLC, said Thongprasert. She referred to a phase III study that found that in patients with adenocarcinoma and large-cell carcinoma histology, the combination of cisplatin and pemetrexed resulted in better overall survival (OS) compared with a cisplatin and gemcitabine combination, while for patients with squamous cell histology, OS was better with a cisplatin and gemcitabine combination compared with cisplatin and pemetrexed. [J Clin Oncol 2008;26:3543-3551]
In another phase III study, advanced NSCLC patients with squamous histology had a better overall response rate to the combination of albumin-bound paclitaxel plus carboplatin compared with solvent-based paclitaxel and carboplatin, while for those with nonsquamous histology, the efficacy between the two treatments was comparable. [J Clin Oncol 2012;30:2055-2062]
Histology dictates the type of chemotherapy as well as the potential addition of antibodies or antiangiogenesis drugs, said Thongprasert.
As both first- and second-line therapy, chemotherapy should be offered to patients with metastatic NSCLC with good Eastern Cooperative Oncology Group (ECOG) performance status, ie, 0, 1 or 2. “However, [as first-line treatment], for ECOG performance status of 2, you probably need to assess patients carefully before giving them chemotherapy,” said Thongprasert. For patients with a performance status of 0 or 1, a combination of two cytotoxic drugs is the standard of care for first-line treatment, she said.