Florida Precision Oncology/A Division of Genesis Care USA, Florida Atlantic University, Aventura, FL.
Miller School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL.
Clin Lung Cancer. 2022 Sep;23(6):457-466. doi: 10.1016/j.cllc.2022.06.002. Epub 2022 Jun 21.
Squamous cell carcinoma (SCC) of the lung has a markedly different molecular profile to adenocarcinoma of the lung and remains difficult to treat because of the lack of targeted therapies for this type of non-small cell lung cancer (NSCLC). With immune checkpoint inhibitors moving from second-line treatment to first-line in NSCLC, effective second-line options following immunotherapy is an urgent unmet need. Appropriate treatment decisions are currently hindered by a lack of prospective clinical data. However, available real-world data suggest that ramucirumab plus docetaxel warrants prospective evaluation in this setting. Also, afatinib is approved in the second line in patients with SCC progressing on first-line platinum-based chemotherapy and may also be an option following immunochemotherapy combinations. Afatinib has the advantage of oral administration with a well-defined tolerability profile. Docetaxel, gemcitabine and platinum-based chemotherapy may be options for some patients, but overall, there are very few options for patients requiring second-line treatment after immunotherapy. This lack of options has prompted efforts to further define the molecular profile of lung SCC to match patients with relevant targeted therapies and to elucidate additional genomic targets. In order to ensure patients with SCC of the lung receive optimal treatment, genomic testing is essential to identify those patients who might benefit from existing targeted agents or clinical trials, and further prospective data are urgently required to assess potential second-line regimens following immunotherapy.
肺鳞状细胞癌（SCC）的分子谱与肺腺癌明显不同，由于缺乏针对这种非小细胞肺癌（NSCLC）的靶向治疗方法，因此仍然难以治疗。随着免疫检查点抑制剂在 NSCLC 中从二线治疗转为一线治疗，免疫治疗后有效的二线治疗选择成为迫切需要满足的需求。目前，由于缺乏前瞻性临床数据，适当的治疗决策受到阻碍。然而，现有的真实世界数据表明，在这种情况下，ramucirumab 联合多西他赛值得前瞻性评估。此外，阿法替尼在一线含铂化疗进展的 SCC 患者中获批二线治疗，在免疫化疗联合治疗后也可能是一种选择。阿法替尼具有口服给药的优势，其耐受性特征明确。多西他赛、吉西他滨和含铂化疗可能是某些患者的选择，但总体而言，免疫治疗后需要二线治疗的患者选择非常有限。这种治疗选择的缺乏促使人们进一步确定肺 SCC 的分子谱，以匹配具有相关靶向治疗的患者，并阐明其他基因组靶点。为了确保肺 SCC 患者接受最佳治疗，基因检测对于确定可能受益于现有靶向药物或临床试验的患者至关重要，迫切需要进一步的前瞻性数据来评估免疫治疗后的潜在二线治疗方案。
