Dr. Stahel on Treatment Sequencing in Stage IV NSCLC

Rolf A. Stahel, MD, professor in the oncology clinic, University Hospital, Zurich, discusses treatment sequencing in stage IV non—small cell lung cancer (NSCLC). The interview with OncLive was conducted at the 2019 European Lung Cancer Congress in Geneva, Switzerland.

Over the last few years, sequencing in advanced NSCLC has changed, Stahel says. It was a generally simple paradigm a few years ago of frontline chemotherapy followed by an alternative chemotherapy agent in the second-line setting. Because the field has shifted toward single-agent immunotherapy or chemoimmunotherapy in the frontline setting, the approach has shifted in the second-line setting, says Stahel.

Patients who receive immunotherapy alone in the frontline setting—either as monotherapy or in combination—would benefit from a platinum-based combination in the second-line setting, Stahel notes. On the other hand, patients who receive frontline chemoimmunotherapy such as pembrolizumab (Keytruda) plus carboplatin and paclitaxel would benefit from pemetrexed or docetaxel in the second-line setting. Stahel concludes that patients should be stratified to determine the proper approach.