Immune checkpoint inhibitors were then evaluated as initial treatment in combination with platinum-based chemotherapy. As a result, PD-1 axis inhibitors became the preferred second-line therapy after development of progressive disease on a platinum-based doublet. Subsequently, four randomized phase III trials demonstrated significant improvements in survival when compared to docetaxel for patients receiving monotherapy with a programmed death-1 (PD-1) axis inhibitor ( 5- 8). Standard of care for patients with squamous NSCLC who developed progressive disease on platinum-based doublets was either (I) docetaxel with or without ramucirumab or (II) gemcitabine ( 3, 4). Median overall survival (OS) with these regimens was 10–12 months and 5-year OS was estimated at 2% ( 1, 2). Patients with stage IV squamous non-small cell lung cancer (NSCLC) were historically treated with first-line platinum-based therapy. Pembrolizumab plus chemotherapy for squamous non-small-cell lung cancer. Not externally peer reviewed.Ĭomment on: Paz-Ares L, Luft A, Vicente D, et al. Email: and Peer Review: This is an invited article commissioned by the Editorial Office of Translational Lung Cancer Research. Division of Medical Oncology, Department of Internal Medicine, Thoracic Oncology Program, University of Colorado Cancer Center, Aurora, CO 80045, USA. Note: dexamethasone doses on day 2 and 3 may not be required and may be reduced or omitted at the clinicians discretion *Correspondence to: Jose M. ONCE a day (or in divided doses) with or after food. 6 AUC dose > 900 mg), obtaining direct measurement rather than an estimated renal function and/or dose capping is strongly recommended) In 500 mL glucose 5% over 30 to 60 minutes (if estimated GFR is > 125 mL/min (i.e. In 500 mL sodium chloride 0.9% over 3 hours In 50 mL sodium chloride 0.9% over 30 minutes The night before chemotherapy with or after foodĦ0 minutes before chemotherapy (fixed dose preparation with palonosetron)Ħ0 minutes before chemotherapy (fixed dose preparation with netupitant) The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS. One off loading doses and ongoing maintenance doses are not included in protocol cost calculations. The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m 2 weight of 75 kg and creatinine clearance of 75 mL/min. The cost of oral continuous therapy is based on a 28 day month. Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. These costs are reviewed and updated on eviQ at 6 monthly intervals. The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.ĭrug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (MIMS Online and other sources. The cost displayed on the protocol is intended as rudimentary guide only for the Australian context. Pembrolizumab is PBS authority Cost: ~ $7,960 per cycle "How this cost is calculated" Drug status:Ĭarboplatin and paclitaxel are on the PBS general schedule Radiation recall has been observed with PD1 inhibitors, consideration should be given to the timing when starting this treatment after a prolonged course of radiation therapy. ![]() While this is rare, (~5%), continuing treatment and performing a second scan 4 to 6 weeks later to confirm progression may be considered, particularly if the patient is believed to be deriving clinical benefit. In the first few months after the start of immunotherapy, some patients can have a transient tumour flare (termed 'pseudo progression' or an immune response). This may manifest as growth of existing lesions or the development of new lesions prior to later tumour regression. 6 AUC dose >900 mg), obtaining direct measurement rather than an estimated renal function and/or dose capping is strongly recommended Frequency:ģ5 or until disease progression or unacceptable toxicity (total maximum of 35 doses or 24 months treatment with pembrolizumab) paclitaxel 175 mg/m 2 and carboplatin AUC 5 should be considered if clinically indicated. It is the consensus of the eviQ Reference Committee that lower starting doses e.g. How you have radiation therapy treatment.How you have anticancer medicine treatment.Fertility, sex, pregnancy and breastfeeding. ![]() Complementary and alternative medicines. ![]() Genetic testing using cancer gene panels.Genetic testing for heritable pathogenic variants.
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