What is the role of histology in treatment selection for non-small cell lung cancer (NSCLC)?

Updated: Jul 15, 2021
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

Answer

Histology must be determined by pathologic review for NSCLC. Histologic findings may influence therapeutic choices, as follows:

  • Pemetrexed is indicated for non-squamous tumors only. [13, 7]

  • Bevacizumab is contraindicated for squamous tumors due to the risk of pulmonary hemorrhage.

  • Erlotinib has higher response rates for adenocarcinomas with EGFR mutations.

  • Erlotinib should be considered for patients with EGFR mutations (activating mutations in exons 19 or 21); patients with the highest response rates typically are Asian, female, have never smoked or are light smokers, and have adenocarcinomas; response rates in unselected populations can be 10-20% or lower but increase to up to 90% in selected populations. [7, 33, 73, 74, 75, 76, 77, 78, 79]


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