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Elderly Man Hands

EVERY ADVANCE MATTERS

Treating squamous NSCLC can be a challenge.

Patients deserve a therapy that’s right for them.

An arrow pointing downward.

Squamous NSCLC

Squamous non-small cell lung cancer (NSCLC) is an aggressive form of cancer, representing approximately one-third of all NSCLC.1 Patient comorbidities make this a difficult disease to treat.2 Although several oncogenic drivers have been identified in NSCLC—leading to targeted therapies—these are rare in squamous histology.3-6 With more options, more patients can benefit from advanced treatments.

Squamous NSCLC is a hard-to-treat disease2,13—additional treatments beyond chemotherapy are needed

Squamous NSCLC tumors are often centrally located and aggressive13: the tumors grow quickly14,15 and invade nearby tissue,13 before metastasizing to other parts of the body.16 Patient comorbidities, which are often smoking related, only add to the difficulty of treating this disease.2

Platinum-based doublet chemotherapy, with an expected median overall survival of approximately 8-10 months, was the standard of care in first-line treatment for over 2 decades.17-20 While a number of oncogenic drivers with effective treatments have been identified in NSCLC—mutations in the epidermal growth factor receptor (EGFR) kinase; fusions involving anaplastic lymphoma kinase (ALK); chromosomal rearrangements of the proto-oncogene receptor tyrosine kinase (ROS1)—they are rarely found in squamous histology.3-6 As a result, few patients with squamous NSCLC can benefit from these treatments.3,4

Tumor Location

Squamous NSCLC tumors are centrally located and aggressive13

2/3 of squamous NSCLC tumors are centrally located close to blood vessels13

  • Due to their central location, squamous NSCLC tumors may be more likely to invade larger blood vessels and bronchi, leading to potentially fatal complications13,21:
    • – Post-obstructive pneumonia
    • – Hemorrhage

Sites of Metastasis

Squamous NSCLC commonly metastasizes to other parts of the body16

Sites of Squamous Lung cancer Metastases

Comorbidities

Most patients with NSCLC—including nonsquamous and squamous—have a history of smoking and serious comorbidities22

Squamous Lung Cancer Comorbidities

Oncogenic drivers with effective treatments are rare in squamous NSCLC3-6

Pie Chart

§Although a recent study reported two positive ROS1 cases, ROS1 has a very low prevalence in squamous cell carcinoma (0/214 patients).5,6

  • Due to the low occurrence of oncogenic drivers, platinum-based doublet chemotherapy is the standard of care in first-line advanced or metastatic squamous NSCLC3,4,17,18
  • Investigations of broadly expressed therapeutic targets, chromosomal and somatic copy number alterations, and gene mutations remain valid approaches4
Pie Chart

§Although a recent study reported two positive ROS1 cases, ROS1 has a very low prevalence in squamous cell carcinoma (0/214 patients).5,6

References

  1. American Cancer Society. What is non-small cell lung cancer? http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-what-is-non-small-cell-lung-cancer. Accessed April 20, 2016.
  2. Asmis TR, Ding K, Seymour L, et al. Age and comorbidity as independent prognostic factors in the treatment of non-small-cell lung cancer: a review of National Cancer Institute of Canada Clinical Trials Group trials. J Clin Oncol. 2008;26(1):54-59.
  3. Pao W, Girard N. New driver mutations in non-small-cell lung cancer. Lancet Oncol. 2011;12(2):175-180.
  4. Perez-Moreno P, Brambilla E, Thomas R, Soria JC. Squamous cell carcinoma of the lung: molecular subtypes and therapeutic opportunities. Clin Cancer Res. 2012;18(9):2443-2451.
  5. Zhao W, Choi Y, Song J, Zhu Y, et al. ALK, ROS1 and RET rearrangements in lung squamous cell carcinoma are very rare. Lung Cancer. 2016;94:22-27.
  6. Davies KD, Le AT, Theodoro MF, et al. Identifying and targeting ROS1 gene fusions in non-small cell lung cancer. Clin Cancer Res. 2012:18(17):4570–4579.
  7. From Ferlay J, Soerjomataran I, Ervik M, et al. GLOBOCAN 2012 v1.0. Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France. International Agency for Research on Cancer; 2013. Available from http://globocan.iarc.fr. Accessed April 20, 2016.
  8. SEER Cancer Statistics Factsheets: Lung and Bronchus Cancer. National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/statfacts/html/lungb.html. Accessed April 20, 2016.
  9. SEER Cancer Statistics Factsheets: Colon and Rectum Cancer. National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/statfacts/html/colorect.html. Accessed April 20, 2016.
  10. SEER Cancer Statistics Factsheets: Prostate Cancer. National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/statfacts/html/prost.html. Accessed April 20, 2016.
  11. SEER Cancer Statistics Factsheets: Breast Cancer. National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/statfacts/html/breast.html. Accessed April 20, 2016.
  12. The EUROCARE-4 database on cancer survival in Europe. http://www.eurocare.it/Results/tabid/79/Default.aspx. Accessed December 4, 2014.
  13. Rosado-de-Christenson ML, Templeton PA, Moran CA. Bronchogenic carcinoma: radiologic-pathologic correlation. Radiographics. 1994;14(2):429-446.
  14. Wilson DO, Ryan A, Fuhrman C, et al. Doubling times and CT screen-detected lung cancers in the Pittsburgh lung screening study. Am J Respir Crit Care Med. 2012;185:85-89.
  15. Veronesi G, Maisonneuve P, Bellomi M, et al. Estimating overdiagnosis in low-dose computed tomography screening for lung cancer: a cohort study. Ann Intern Med. 2012;157(11):776-784.
  16. Rubin E, Reisner HM, eds. Essentials of Rubin's Pathology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009: 268-270.
  17. Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non-Small Cell Lung Cancer V.1.2016. © National Comprehensive Cancer Network, Inc 2015. All rights reserved. Accessed April 20, 2016. To view the most recent and complete version of the guidelines, go online to http://nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN content are trademarks owned by the National Comprehensive Cancer Network, Inc.
  18. Reck M, Popat S, Reinmuth N, et al. Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(suppl 3):iii27-iii39.
  19. Hoang T, Dahlberg SE, Schiller JH, Johnson DH. Does histology predict survival of advanced non-small cell lung cancer patients treated with platin-based chemotherapy? An analysis of the Eastern Cooperative Oncology Group Study E1594. Lung Cancer. 2013;81(1):47-52.
  20. Ellis LM, Bernstein DS, Voest EE, et al. American Society of Clinical Oncology perspective: raising the bar for clinical trials by defining clinically meaningful outcomes. J Clin Oncol. 2014;32(12):1277-1280.
  21. Nichols L, Saunders R, Knollmann FD. Causes of death of patients with lung cancer. Arch Pathol Lab Med. 2012;136(12):1552-1557.
  22. Little AG, Gay EG, Gaspar LE, Stewart AK. National survey of non-small cell lung cancer in the United States: epidemiology, pathology and patterns of care. Lung Cancer. 2007;57(3):253-260.