Chemotherapy Approaches in Locally Advanced NSCLC

D. Ross Camidge, MD, PhD:There are at least 3 well-recognized chemotherapy regimens that are used as radiation sensitizers. The mild is weekly carboplatin/paclitaxel, which is predominantly reserved for very frail patients. The worry is that the systemic dose is relatively small. And given that the function of the chemotherapy is partly to make the radiotherapy more effective, but also to have an effect on hidden metastatic disease, that’s a worry. I think for that reason, the so-called SWOG regimen of day 1 and day 8 cisplatin and days 1 through 5 etoposide on a 28-day cycle is probably most commonly used for everyone except for the very frail patients.

In recent years, CALGB did show that full-dose carboplatin/pemetrexed was about the same in terms of equivalence, maybe a slightly higher rate of pneumonitis. And I still use that, but I only use that for patients who I know have a gene rearrangement. That comes from a large amount of data that the gene rearrangement disease is ALK, ROS1, RET, even NTRK are particularly sensitive to pemetrexed. So, only in those patients am I using a pemetrexed-based regimen.

Using EGFR inhibitors in chemoradiotherapy, I would say, has almost no role. It doesn’t work for somebody who doesn’t have anEGFRmutation. If you had anEGFRmutation, there is a clinical trial going on to see whether induction, maybe at 6 weeks, of EGFR-TKI could make the treatment more effective when you then go on to standard chemoradiotherapy. But I see no role for combining it together.

Transcript edited for clarity.