Recommendations on First-line Chemotherapeutic Options for Advanced Non-Small Cell Lung Cancer (NSCLC) Negative for Driver Mutation

For fit patients, chemotherapy that involves the combination of a platinum-based drug and another drug should be used.

Pemetrexed is a drug that inhibits production of DNA and RNA and hence prevents cell growth, specifically of cancer cells since they are actively producing DNA and RNA. Chemotherapy involving a combination of pemetrexed and platinum is preferred in treatment of non-squamous advanced NSCLC. Non-squamous NSCLC refers to the non-flat shape of cancer cells determined from examinations such as a biopsy, where a sample of the tumour is removed for analysis. This allows doctors to categorize types of cancer.

Bevacizumab is a drug that inhibits growth of blood vessels that cancers need to support growth, thus preventing the growth of cancer cells. Bevacizumab can be added to chemotherapy, but this is limited to non-squamous cancer.

Some cancer cells have proteins on their surface called epidermal growth factor receptors (EGFRs). EGFR inhibitors such as cetuximab inhibit the function of these proteins, preventing them from promoting growth of cancer cells. However, for this case, cetuximab is not recommended.