An update to guidelines on treating NSCLC

This study summarized updated guidelines for the appropriate treatments for patients with non-small cell lung cancer (NSCLC).

Most patients with NSCLC are not diagnosed until the disease is advanced (spread) and survival rates at this late stage of cancer are low. Therefore, it is important that doctors are aware of the most up to date and appropriate treatments for different types of NSCLC.

Recently, immunotherapies such as nivolumab (Opdivo) and pembrolizumab (Keytruda) have been studied extensively in the treatment of this disease. This review by the National Comprehensive Cancer Network was conducted to update guidelines and recommendations for the use of immunotherapies in the treatment of NSCLC. 

Nivolumab is recommended as the preferred treatment for patients with advanced squamous and non-squamous cell NSCLC who have progressed despite chemotherapy. For patients with advanced squamous cell NSCLC, those treated with nivolumab had a 41% improved chance of a longer overall survival (time from treatment until death from any cause) than those treated with the chemotherapy docetaxel (Taxotere). They also had fewer side effects. 7% of patients treated with nivolumab experienced a serious side effect, compared to 55% of patients treated with docetaxel.

For patients with advanced non-squamous cell NSCLC, nivolumab was associated with a 27% increased chance of a longer overall survival compared with docetaxel. 10% of patients treated with nivolumab had serious side effects compared to 54% of patients treated with docetaxel.

Pembrolizumab is recommended as a treatment following chemotherapy in patients with either squamous or non-squamous NSCLC who express the PD-1 receptor. The chance of a longer overall survival was 29–39% better for patients treated with pembrolizumab  than for patients treated with docetaxel. In patients with tumors expressing the PD-1 receptor, pembrolizumab was associated with a 46­–50% increase in the odds of a longer overall survival.

In addition, only 13–16% of these patients had serious side effects, compared to 35% of patients on docetaxel.  In both trials, patients who had a mutation (permanent change) in the EGFR gene had longer overall survival when treated with docetaxel.

Authors updated guidelines on which NSCLC patients benefit most from treatment with nivolumab and pembrolizumab.