What are the treatment options for metastatic SCC?

Question

Hi doctor,

My dad is 55 and was diagnosed with metastatic poorly differentiated squamous carcinoma in the left mediastinum. He has never smoked, which I am told makes this unusual. He has undergone treatment with Carboplatin, Paclitaxel, and Pembrolizumab, followed by Cisplatin, Gemcitabine, and Pembrolizumab, then Atezolizumab, and finally Carboplatin and Etoposide.

His counts are low now, and it feels like options are running out. What else can be done?

Please help.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

A never-smoker getting squamous cell lung cancer is a real diagnostic flag. With a large mediastinal mass and pleural nodules, this could be thymic carcinoma, which gets misdiagnosed as squamous cell lung cancer fairly often. I would run IHC for CD117 to help tell them apart.

With his counts where they are and chemo options getting limited, targeted therapy is the next move. I would go with either Sunitinib (Sutent) or Lenvatinib (Lenvima) first. If those options are not suitable, Gemcitabine (Gemzar) plus Capecitabine (Xeloda) or Everolimus (Afinitor) are still available.

He has been through several PD-1 inhibitors without much benefit, even with high PDL-1 expression. If he wants to try immunotherapy again, combining Ipilimumab (Yervoy) with Nivolumab (Opdivo) could be an option. We also looked at CAR-T and tumor-infiltrating lymphocyte trials, but his cytopenias from prior chemo are a problem since those cellular therapies require myeloablative chemo first, and his counts likely cannot handle that right now.

At this point, it is important to double-check the diagnosis and see if any clinical trials are a fit. Doing broader molecular testing or next-generation sequencing could also pick up on rare targets.

And alongside treatment, bringing in palliative care can really help with symptom control and overall quality of life while you figure out next steps.

I hope this information will help you.

Thanks.