Chemotherapy Regimens in Metastatic NSCLC

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Doublet platinum therapy is often used to treat individuals with non-squamous, non-small cell lung cancer (NSCLC) who have a good performance status, says Mark A. Socinski, MD. Two commonly used regimens are carboplatin with paclitaxel and carboplatin with pemetrexed.

There aren't any significant difference in overall response between the two regimens; however, there are notable differences in their toxicity profiles, notes Socinski. Pemetrexed is associated with substantially less alopecia than paclitaxel but is more toxic in the setting of renal dysfunction. Paclitaxel may cause more adverse events, including fatigue, anemia, and thrombocytopenia.

Squamous cell histology is usually managed with either a taxane or gemcitabine-based doublet, comments Socinski. Compared with solvent-based paclitaxel, the combination of nab-paclitaxel and carboplatin was superior in overall response rate, with a 26% response rate with solvent-based paclitaxel and a 41% response rate with nab-paclitaxel. An improvement in response may correlate with relief of symptoms, such as cough, chest pain, shortness of breath, fatigue, and poor appetite, Socinski notes.

In addition to frontline treatment, maintenance therapy has been shown to improve survival for patients with NSCLC, notes Socinski. The two drugs that tend to be used in the first 2 to 4 cycles of frontline therapy, bevacizumab and pemetrexed, are the ones typically used as part of continuation maintenance.

In the AVAPERL study, patients received first-line bevacizumab, cisplatin, and pemetrexed for four cycles followed by maintenance bevacizumab alone or in combination with pemetrexed. The median progression-free survival was 7.4 months with the combination versus 3.7 months for single-agent bevacizumab (HR = 0.48; P < .001). Overall survival was numerically longer with bevacizumab-pemetrexed versus bevacizumab at 17.1 versus 13.2 months (HR = 0.87; P = 0.29); however, only 58% of events had occurred at the time of the analysis.