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NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

A fit patient with metastatic lung adenocarcinoma and no actionable driver progresses after platinum-pemetrexed plus pembrolizumab. There is no contraindication to antiangiogenic treatment. Which NICE-listed cytotoxic option is appropriate next?

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Correct answer: D — Docetaxel with nintedanib for adenocarcinoma histology

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

E is correct. NICE recommends nintedanib with docetaxel for locally advanced, metastatic or recurrent NSCLC of adenocarcinoma histology after first-line chemotherapy. Previous chemo-immunotherapy does not make an EGFR-wild-type tumour sensitive to erlotinib, and continuation of pemetrexed or pembrolizumab through unequivocal progression is not routine. Gemcitabine may be considered in selected later-line situations, but adding maintenance pembrolizumab after progression is unsupported. Before nintedanib, bleeding, thrombotic, gastrointestinal and wound-healing risks, liver function and patient preference require review; the option is not interchangeable with docetaxel alone in every patient.

Reference: NICE TA347 nintedanib with docetaxel recommendations: https://www.nice.org.uk/guidance/ta347/chapter/1-Recommendations