A 58-year-old man presented with haemoptysis, weight loss and worsening breathlessness. He was a lifelong heavy smoker. His chest X-ray was abnormal. A CT scan of chest and abdomen demonstrated a large mass in the right lower lobe invading into the mediastinum and pericardium, extensive mediastinal lymphadenopathy, and bone metastasis (T4, N3, M1b). Bronchoscopy and biopsy confirmed a squamous cell carcinoma. Mutation analysis revealed that EGFR and K-ras genes were both wild type. What is the most appropriate first-line therapy?

Question

Quizplus · Accepted Answer

The most appropriate first-line therapy for a patient with squamous cell carcinoma of the lung, especially with extensive disease (T4, N3, M1b) and without actionable mutations (EGFR and K-ras wild type), is a combination chemotherapy regimen. Gemcitabine and cisplatin is a common choice for squamous cell lung cancer, providing a balance of efficacy and tolerability. Other options like erlotinib and gefitinib (EGFR inhibitors) are less appropriate without evidence of EGFR mutations. Pemetrexed is typically less effective in squamous cell carcinoma compared to non-squamous non-small cell lung cancer.

A 58-Year-Old Man Presented with Haemoptysis, Weight Loss and Worsening