ESMO guideline reports: “In the USA, squamous cell carcinoma (SCC, which was formally the predominant histotype) decreased, while adenocarcinoma has increased in both genders. 
In Europe, similar trends have occurred in men, while in women, both SCC and adenocarcinoma are still increasing”(1).  
Epidemiological data show recently that overall survival (OS) gains more pronounced for patients with adenocarcinoma histology, less for patients with squamous-cell tumors(2).
In this context, our case is relevant for the possibility of treatment in Romania.
We present the case of a 62-year-old man, smoker (20 pack/year), with the following comorbidities: arterial hypertension, hyper colesterolemya, and diabetes mellitus. 
Concomitant medication: tertensif, perindopril.
The main symptoms were: loss of appetite, fatigue, shortness of breath, cough.

Second line chemotherapy

11.02.2016: after approximately 5 months of remission, we had progressive disease and we initiated the second line chemotherapy: Docetaxel 75 mg/m2. Docetaxel was administered (2 cycles) until 24.03.2016, when it was interrupted because of its toxicity (cough, dizziness, asthenia, lack of appetite).
Mono-chemotherapy with oral Vinorelbine 2.3 mg/m2 was indicated between 25.05.2016 and 31.08.2016. 
CT revealed stationary disease. A new CT exam was performed on 18.05.2016.
In 1.06.2016, we initiated the treatment with Erlotinib. Because the CT was not repeated in June, the patient underwent a chest X-ray (18.06.2016), repeated in 19.09.2016. The last X-ray revealed a reduction in mass tumor.  

Comments

Patients with Squamous Cell Carcinoma (CCO)
“In patients without actionable mutations and squamous cell carcinoma histology, the recommended options include platinum-based doublets or the platinum-based doublet gemcitabine and cisplatin combined with necitumumab”.
Patients with squamous NSCLC had improved OS when treated with cisplatin/gemcitabine vs. cisplatin/ pemetrexed (10.8 vs. 9.4 months; p=.05).
Necitumumab, an anti-EGFR monoclonal antibody, is approved by the FDA as first-line treatment of metastatic, squamous NSCLC, in combination with gemcitabine and cisplatin.
Cisplatin vs. carboplatin

• The benefit of cisplatin vs. carboplatin for the treatment of advanced NSCLC is controversial.
• Treatment-related adverse events should be considered during treatment selection.

 Cisplatin associated with increased nausea, vomiting, neurotoxicity, and renal toxicity.
 Carboplatin associated with thrombocytopenia.
 Carboplatin-based regimens were most often used in US regardless of comorbidities.

Other options of treatment

Pembrolizumab (if PD-L1 positive) and nivolumab - other systemic therapy including docetaxel (alone or with ramucirumab) or gemcitabine - ramucirumab is approved for second-line therapy in combination with docetaxel. Afatinib may also be an option for the second-line treatment of patients with advanced squamous NSCLC(3).
In conclusion, most researchers estimate the following aspects in the management of squamous NSCLC:

• Gemcitabine - or Taxane-based regimens commonly used remains the standard of care (nab-paclitaxel may be the most active).
• Antiangiogenic strategies are too toxic.
• Pemetrexed is no longer approved for use in this subset.
• Positive Phase III trial with necitumumab, with cisplatin and gemcitabine.
• Several new molecular targets have been identified in this subset of NSCLC.
• New strategies are needed for this large group of patients(4).

Case particularities 

Typical central squamous carcinoma of the lung in a former smoker. 
Typical response to radiotherapy. 
Sensitivity to chemotherapy, including mono chemotherapy with oral Vinorelbine which replaced Docetaxel because of the toxicity induced.
Uncommon sensitivity to erlotinib but that can not yet be demonstrated.  cancer pulmonarnon small-cell lung cance