Non Small Cell Stage IV Treatment Overview
The general treatment for stage four non-small cell lung cancer will either be chemotherapy plus immune therapy or immune therapy alone or chemotherapy alone, but traditionally it’s going to be chemotherapy plus immune therapy. The most important chemotherapy agent that is recommended first line is a platinum drug, usually carboplatin or cisplatin, but carboplatin is usually better tolerated. That will be combined oftentimes with a taxol, usually paclitaxel. Some of the first line immune therapy options to combine with the chemo and then use by themselves as a maintenance will be ipilimumab with nivolumab or a atizoluminab, or pembrolizumab. There’s also a bunch of other immune therapies, but generally the consensus is chemo plus immune therapy. Through that course, and unfortunately, as the cancer outsmarts some of these chemotherapy agents, then you go towards a single agent chemotherapy. Some of these could be docetaxel, gemcitabine, as well as using adjuncts that aren’t standard cytotoxic chemotherapy like bevicuzimab. So towards the second and third and fourth line of lung cancer treatment, you basically try single agent chemotherapies plus / minus an adjunctive or non-cytotoxic agent with the chemotherapy to try and get control. We go through these single agent adjunct therapies and cytotoxic chemotherapies later on in the series.