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NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

A 68-year-old man with stage IV squamous NSCLC (PD-L1 TPS 0%, EGFR/ALK wild-type) has an excellent response to first-line pembrolizumab + carboplatin + paclitaxel after 4 cycles. What is the appropriate maintenance strategy for squamous histology?

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Correct answer: E — Continue pembrolizumab alone as maintenance after four induction cycles

After four pembrolizumab-carboplatin-taxane induction cycles for squamous NSCLC, pembrolizumab alone is continued as maintenance. Continue pembrolizumab plus paclitaxel after four induction cycles: maintenance paclitaxel adds cumulative neuropathy and is not the trial maintenance phase. Continue pembrolizumab plus carboplatin after four induction cycles: maintenance platinum adds marrow toxicity and was not continued in the regimen. Continue pembrolizumab plus pemetrexed after four induction cycles: pemetrexed maintenance applies to nonsquamous rather than squamous histology. Continue pembrolizumab plus carboplatin-paclitaxel for eight induction cycles: the cytotoxic induction course is four cycles rather than prolonged indefinitely.

Reference: KEYTRUDA 25 mg/mL UK summary of product characteristics (Current UK SmPC, updated June 2026): https://www.medicines.org.uk/emc/product/2498/smpc; NICE NG122 lung cancer: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng122/chapter/Recommendations