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The standard of care for patients with stage IV NSCLC is a platinum-based doublet regimen. The non-platinum agent (eg, a taxane or pemetrexed) is often selected based on the patient’s tumor histology, comments Primo N. Lara, Jr, MD. Individuals with nonsquamous disease are often treated with pemetrexed, as it has shown to be more effective in patient populations with nonsquamous histology. Lara also considers the addition of bevacizumab because it has been shown to prolong survival when used in combination with a platinum-based doublet.
The optimal regimen for patients with squamous cell histology has not been established, although it is known that the platinum doublet should not include pemetrexed. Potential doublets include carboplatin or cisplatin with paclitaxel, nab-paclitaxel, gemcitabine, or docetaxel.
A large randomized trial of a platinum-based doublet with or without the EGFR-targeted monoclonal antibody necitumumab demonstrated a modest survival benefit in individuals with squamous cell histology. Lara notes that this is one of the first clinical trials to demonstrate a survival advantage for a targeted agent in combination with cytotoxic chemotherapy in squamous cell carcinoma.