Rounds with the Investigators 2012 | Lung

QUESTION: I have a 72 yo male with a non-small cell lung cancer with squamous differentiation who presented with metastatic disease to lung and liver. After 4 cycles of carbo/paclitaxel he has had an excellent response with complete disappearance of disease in neck and on CT of liver. If this were nonsquamous I would employ a maintenance strategy probably with pemetrexed, but erlotinib would also be a consideration. Would there be any suggestion for use of maintenance in this patient?

DR JYOTI PATEL: This is the platinum/gemcitabine as the original maintenance, I guess. We have data that would suggest from a progression-free survival endpoint, an older trial, the Brodowicz trial, that shows gemcitabine continuation is okay. We have the IFCT trial, the Fidias trial. I mean, there are options for maintenance for him, whether it’s switch or continuation.

And the question would become: How symptomatic is he? What’s his quality of life after significant exposure to carboplatin and paclitaxel? My inclination for most patients with squamous cell tumors is to stop treatment and to give a bit of a break. But if he’s had a stellar response and is tolerating the therapy, then it wouldn’t be unreasonable.

Finally, erlotinib has an FDA indication, albeit modest, but certainly erlotinib would be okay to do.

DR NEIL LOVE: What do you think about erlotinib as maintenance, Tom, in the nonmutant kind of patient? And for that matter, second- and third-line therapy? A very common question we get.

DR THOMAS LYNCH: I use it in second- and third-line therapy in nonmutated patients, but it’s not with incredible enthusiasm, as I think you’re seeing from Jyoti in her comments — meaning yes, it’s indicated, yes, it’s an option, and I think there’s not a person in this room who hasn’t used it in second- and third-line lung cancer when you don’t have any other options. I just don’t think it’s an incredible drug in those settings. I think it has some benefit, but I obviously would rather use it in mutants. But if you have someone who doesn’t have a mutation, it is an option for second- and third-line therapy.