Treating Driver Mutation Negative NSCLC

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Regimens commonly used to treat individuals with mutation-negative, non-squamous histology non-small cell lung cancer (NSCLC) include bevacizumab and carboplatin in combination with paclitaxel or pemetrexed, Thomas E. Stinchcombe, MD, states. In squamous NSCLC treatment options are more limited, and in this population Stinchcombe generally uses carboplatin/gemcitabine or carboplatin with a paclitaxel.

Performance status and age are important determinants in how to treat patients, says Anne S. Tsao, MD. As a result, bevacizumab may not be appropriate for individuals who are over age 75, as this patient population is at higher risk of complications and toxicities from bevacizumab therapy.

For those without mutations, new findings have suggested that PD-1 inhibition with nivolumab could be a potential option. In a collection of two phase III studies, nivolumab was shown to improve overall survival in pretreated patients with NSCLC regardless of histology compared with docetaxel. Nivolumab is approved by the FDA in squamous NSCLC. Bristol-Myers Squibb (BMS), the manufacturer of nivolumab, has applied for an additional indication in the nonsquamous setting.