Squamous carcinoma accounts for about 25-30% or so of non-small cell lung cancer. Currently, regarding advanced lung adenocarcinoma, with the gradual clarification of the driver genes, targeted therapeutic agents targeting the corresponding driver genes have been widely used in the clinic, and there are clear roadmaps and flow charts for first-, second-, and third-line therapies. However, for patients with advanced squamous lung cancer, which accounts for a large clinical population, what progress has been made in the past time, and how to optimize the overall treatment strategy of advanced squamous lung cancer so as to maximize the overall survival of squamous lung cancer patients? Prof. Song Yong from Nanjing General Hospital of Nanjing Military Command gave us a rundown of some of the current advances at this year’s CSCO Congress. Current treatment status It goes without saying that platinum-containing double agents are still the gold standard of first-line treatment in advanced squamous lung cancer, and the combination of the big four (paclitaxel, doxorubicin, vincristine, gemcitabine) and cisplatin or carboplatin seems to have entered a bottleneck stage. It is difficult to distinguish between them in terms of PFS and OS. Then, the exploration of the improvement of paclitaxel—targeted binding of albumin into the albumin-binding paclitaxel (commonly known as nano-paclitaxel, nab-PC) plus carboplatin vs. Paclitaxel plus carboplatin was also declared a failure in the CA013 study, his mPFS, as well as the mOS were only 5.6 months, and 10.7 months, respectively, compared with the control group were 5.7 months and 9.5 months, respectively, the p-value is not statistically significant. were 5.7 and 9.5 months, respectively, in the control group, with P values not statistically significant. In addition, a Japanese study, WJOG 5208L, was conducted in an attempt to replace cisplatin with nedaplatin to reduce toxicities and improve efficacy. The conclusion was that the 2-year OS was 27.1% in the nedaplatin group versus 18.1% in the control group (p=0.037), and no statistically significant difference in median PFS was seen between the two groups. Professors Wu Yilong and Lu Shun in China are also conducting studies to validate the efficacy of nedaplatin in the Chinese population and look forward to their data to answer this question. So, in the real world in the United States, for advanced squamous lung cancer, the first line is still a combination of paclitaxel, docetaxel, gemcitabine and cisplatin and carboplatin. If switching chemotherapeutic agents doesn’t work, does adding an anti-tumor angiogenesis agent work? The answer is partially no. In one study of paclitaxel plus carboplatin plus bevacaine, because of six cases of life-threatening pulmonary hemorrhage and four fatalities, even the latest version of the NCCN guidelines exclude squamous lung cancer from the indication for bevacaine. Fortunately, an anti-angiogenic drug targeting VEGF-2 (ramucirumab) was approved by the FDA for second-line antitumor angiogenic therapy because it significantly improved the PFS and OS of NSCLC patients who had failed the first-line treatment in the REVAL study in combination with docetaxel compared with single-agent docetaxel. Of course, Endo, a vascular endothelial inhibitor developed and manufactured in China, has been approved for use in advanced lung cancer, including squamous lung cancer, due to its excellent efficacy and relatively small side effects, especially the low risk of bleeding. The arduous road of discovery Unlike the feverish progress of targeted therapy for lung adenocarcinoma, the highly heterogeneous nature of tumors and high mutation load of lung squamous carcinoma make it difficult to find a clear target for treatment in the clinic. However, there is no lack of bright spots. In the LUX-Lung 8 study, the second-line second-generation EGFR-TKI afatinib against erlotinib for advanced squamous lung cancer was approved for the treatment of squamous lung cancer in the United States and Europe in 2016 due to its advantageous PFS and OS, which were 2.6 vs. 1.9M, p=0.0103 and 7.9 vs. 6.8M, p=0.0077, respectively. Unfortunately, at present, afatinib is not available in China. Immunotherapy has seen the light of day Can the star drugs of recent years, anti-PD-1 antibody or anti-PD-L1 antibody, have a place in squamous lung cancer? The answer is yes. In the checkmate-017 study, the 2-year survival rate of Nivolumab versus docetaxel for second-line treatment of squamous lung cancer patients reached 23-29%, which was significantly higher than that of the control group (15%), and in addition, there was a statistically significant improvement in PFS or ORR. advanced squamous lung cancer. Another big hit, Pem brolizumab, was also approved by the FDA for the treatment of metastatic non-small cell lung cancer with PD-L1 expression and progression on platinum-containing regimens due to its excellent efficacy in patients with high PD-L1 expression, with an ORR of 45.2% and a PFS of 6.3 months. Of course, it is worth pointing out that these drugs are expensive, and it may take a long time to see whether they can serve the majority of lung cancer patients in China. In conclusion. Currently, the overall treatment strategy regarding advanced squamous lung cancer is still platinum-containing dual-drug-based chemotherapy. If conditions permit (economic, drug accessibility, etc.), ramucirumab plus chemotherapy or immunotherapy can be used. The road of exploration in the future may still be hard!