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{{Lung cancer}}
{{Lung cancer}}


{{CMG}}; '''Associate Editor(s)-In-Chief:''' Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, {{CZ}}
{{CMG}}; {{AE}} {{STA}}
 
==Overview==
==Overview==
The use chemotherapy and the specific regimen used depends on the tumor type.  
[[Medical]] [[therapy]] for lung cancer consists of [[radiation therapy]], [[chemotherapy]], and targeted [[therapy]].


==Medical Therapy==
==Medical Therapy==
The medical therapy for lung cancer consists of surgery, radiation therapy, chemotherapy, and targeted therapy.


==Surgery==
* The table below summarizes the treatment for each [[Cancer staging|stage]] of lung cancer for those who either refuse or unable to tolerate [[surgery]].
To view the surgery of lung cancer, click [[Lung cancer surgery|'''here''']]
 
{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}}
 
| style="background:#f0f0f0;" align="center" |'''Stage'''
 
| style="background:#f0f0f0;" align="center" |'''Treatment'''
 
|-
 
!'''I'''
|
* [[Radiation therapy]] AND consider [[chemotherapy]] for high risk stage IB
 
|-
 
!'''II (T2a, N0 OR T3, N0)'''
|
* Consider [[chemotherapy]] for high risk stage II AND [[radiation therapy]]
 
|-
 
!'''II (T1a, N1 OR T1b, N1 OR T2a, N1 OR T2b, N1)'''
|
* [[Chemotherapy|Chemo]]-[[Radiation therapy|radiation]]
 
|-
 
!'''III'''
|
* [[Chemotherapy|Chemo]]-[[Radiation therapy|radiation]]
 
|}
 
* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage I who can tolerate [[surgery]]:''' <ref>http://www.nccn.org/patients/guidelines/nscl/#56/z</ref>.
 
[[Image:Stage I.jpg|800px]]
<br />
 
* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage II without invasion who can tolerate [[surgery]]: <ref>http://www.nccn.org/patients/guidelines/nscl/#58/z</ref>'''
 
[[Image:Stage II without invasion.jpg|800px]]
 
* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage II with invasion who can tolerate [[surgery]]:''' <ref>http://www.nccn.org/patients/guidelines/nscl/#61/z</ref>
 
[[Image:Stage II with invasion.jpg|800px]]
 
* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage III without invasion who can tolerate [[surgery]]:''' <ref>http://www.nccn.org/patients/guidelines/nscl/#63/z</ref><ref>http://www.nccn.org/patients/guidelines/nscl/#64/z</ref>
 
[[Image:Stage III without invasion.jpg|800px]]
 
* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage III with invasion who can tolerate [[surgery]]:''' <ref>http://www.nccn.org/patients/guidelines/nscl/#66/z</ref><ref>http://www.nccn.org/patients/guidelines/nscl/#67/z</ref><br> [[Image:Stage III with invasion.jpg|800px]]
 
* The treatment of '''stage 4''' lung cancers includes [[chemotherapy]] if the [[Eastern Cooperative Oncology Group|Eastern Cooperative Oncology Group (ECOG)]] Performance Scale is between 0 and 2. If the Performance Score is 3 or 4, then supportive care is recommended. <ref>http://www.nccn.org/patients/guidelines/nscl/#72/z</ref>
 
* The [[Eastern Cooperative Oncology Group|Eastern Cooperative Oncology Group (ECOG)]] Performance Scale is the following: <ref>http://www.nccn.org/patients/guidelines/nscl/#71/z</ref>
 
**'''0:''' Fully active
**'''1:''' [[Self-care]] activities but unable to do hard physical work
**'''2:''' [[Self-care]] activities but unable to do any work
**'''3:''' Unable to do any [[self-care]] activities or any work
**'''4:''' Fully [[Disability|disabled]]
 
===Surgery===
 
* To learn about the [[Surgery|surgical]] approach to lung cancer, click [[Lung cancer surgery|'''here''']].
 
===Radiation Therapy===
 
* [[Radiation therapy]] can be administered via the following two methods:
 
==== 1. External Beam Radiation Therapy (EBRT) ====


==Radiation Therapy==
Radiation therapy can be given with either one of two methods:
*External Beam Radiation Therapy (EBRT)
:*This is more commonly used
:*This is more commonly used
:*The body receives radiation from an outside machine
:*The [[Human body|body]] receives [[radiation]] from an outside machine
:*The radiation is given in a series of sessions for about 8 weeks
:*The [[radiation]] is given in a series of sessions for about 8 weeks
*Internal Radiation Therapy (brachytherapy)
 
:*This therapy involves placing a radioactive object in or near the tumor
==== 2. Internal Radiation Therapy (Brachytherapy) ====
:*This can shrink a tumor that blocks the airway
 
*Possible side effects include the following:
:*This approach involves placing a [[radioactive]] object in or near the [[tumor]]
:*Dry, sore, painful skin
:*This can shrink an airway blocking [[tumor]]
:*Hair loss
 
:*Swelling of the lungs or esophagus
*Possible [[side effects]] include the following:
:*Fatigue
 
:*Loss of appetite
:*Dry, [[sore]], [[Pain|painful]] [[skin]]
:*[[Hair loss]]
:*[[Edema|Swelling]] of the [[Lung|lungs]] or [[esophagus]]
:*[[Fatigue]]
:*[[Loss of appetite]]
 
===Chemotherapy for Non Small Cell Lung Cancer===
 
====Chemotherapy Regimens as Neo-adjuvant and Adjuvant Therapy====
*[[Cisplatin]] 50 mg/m² days 1 and 8 AND [[vinorelbine]] 25 mg/m² days 1, 8, 15, 22, every 28 days for 4 cycles<ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>
*[[Cisplatin]] 100 mg/m² day 1 AND [[vinorelbine]] 30 mg/m² days 1, 8, 15, 22, every 28 days for 4 cycles
*[[Cisplatin]] 75 - 80 mg/m² day 1 AND [[vinorelbine]] 25 - 30 mg/m² days 1 + 8, every 21 days for 4 cycles
*[[Cisplatin]] 100 mg/m² day 1 AND [[etoposide]] 100 mg/m² days 1 - 3, every 28 days for 4 cycles
*[[Cisplatin]] 80 mg/m² days 1, 22, 43, 64 AND [[vinblastine]] 4 mg/m² days 1, 8, 15, 22, 29 then every 2 weeks after day 43, every 21 days for 4 cycles
*[[Cisplatin]] 75 mg/m² day 1 AND [[gemcitabine]] 1250 mg/m² days 1, 8, every 21 days for 4 cycles
*[[Cisplatin]] 75 mg/m² day 1 AND [[docetaxel]] 75 mg/m² day 1, every 21 days for 4 cycles
*[[Cisplatin]] 75 mg/m² day 1 AND [[pemetrexed]] 500 mg/m² day 1 for non-squamous (without specific [[Histology|histologic]] sub-type), every 21 days for 4 cycles


===Chemotherapy===
====Chemotherapy Regimens for Patients with Comorbidities or Patients Not Able to Tolerate Cisplatin====
*[[Paclitaxel]] 200 mg/m² day 1, [[carboplatin]] AUC 6 day 1, every 21 days <ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>


====Concurrent Chemotherapy and Radiation Therapy Regimens====
*[[Cisplatin]] 50 mg/m² on days 1, 8, 29, and 36 AND [[etoposide]] 50 mg/m² days 1 - 5, 29 - 33 WITH concurrent [[Chest|thoracic]] [[radiation therapy]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>
*[[Cisplatin]] 100 mg/m² days 1 and 29 AND [[vinblastine]] 5 mg/m²/weekly x 5 WITH concurrent [[Chest|thoracic]] [[radiation therapy]]
*[[Carboplatin]] AUC 5 on day 1 AND [[pemetrexed]] 500 mg/m² on day 1 every 21 days for 4 cycles WITH concurrent [[Chest|thoracic]] [[radiation therapy]]
*[[Cisplatin]] 75 mg/m² on day 1 AND [[pemetrexed]] 500 mg/m² on day 1 every 21 days for 3 cycles WITH concurrent [[Chest|thoracic]] [[radiation therapy]]


===Chemotherapy===
====Sequential Chemotherapy and Radiation Therapy Regimens====
Small cell lung carcinoma, even if relatively early stage, is treated primarily with chemotherapy and radiation<ref>{{cite journal|author=Hann CL, Rudin CM |title=Management of small-cell lung cancer: incremental changes but hope for the future |journal=Oncology (Williston Park)|date=2008 Nov 30|volume=22|issue=13|pages=1486–92}}</ref> as surgery has no demonstrable influence on survival. In small cell lung carcinoma, cisplatin and etoposide are most commonly used.<ref name="Murray">{{cite journal | last =Murray | first =N | coauthors =Turrisi AT | title =A review of first-line treatment for small-cell lung cancer | journal =Journal of Thoracic Oncology | volume =1 | issue =3 | pages =270–278 | date =Mar 2006 | pmid =17409868 }}</ref> Combinations with carboplatin, gemcitabine, paclitaxel, vinorelbine, [[topotecan]] and [[irinotecan]] are also used.<ref name="Azim">{{cite journal | last =Azim |first =HA | coauthors =Ganti AK | title =Treatment options for relapsed small-cell lung cancer | journal =Anticancer drugs | volume =18 | issue =3 | pages =255–261 | date =Mar 2007 | pmid =17264756 }}</ref><ref name="MacCallum">{{cite journal | last =MacCallum |first =C | coauthors = Gillenwater HH | title =Second-line treatment of small-cell lung cancer | journal =Current Oncology Reports |volume =8 | issue =4 | pages =258–264 | date =Jul 2006 | pmid =17254525 }}</ref> In extensive-stage small-cell lung cancer[[celecoxib]] may have a role.<ref name="pmid19266367">{{cite journal| author=Arúajo AM, Mendez JC, Coelho AL, Sousa B, Barata F, Figueiredo A et al.| title=Phase II study of celecoxib with cisplatin plus etoposide in extensive-stage small cell lung cancer. | journal=Cancer Invest | year= 2009 | volume= 27 | issue= 4 | pages= 391-6 | pmid=19266367 | doi=10.1080/07357900802232756 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19266367  }} </ref>
*[[Cisplatin]] 100 mg/m² on days 1 and 29 AND [[vinblastine]] 5 mg/m²/weekly on days 1, 8, 15, 22, and 29 FOLLOWED by [[radiation therapy]] <ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>
*[[Paclitaxel]] 200 mg/m² over 3 hours on day 1 AND [[carboplatin]] AUC 6 over 60 minutes on day 1 every 3 weeks for 2 cycles FOLLOWED by [[Chest|thoracic]] [[radiation therapy]]


Primary chemotherapy is also given in metastatic non-small cell lung carcinoma. Advanced non-small cell lung carcinoma is often treated with [[cisplatin]] or [[carboplatin]], in combination with [[gemcitabine]], [[paclitaxel]], [[docetaxel]], [[etoposide]], or[[vinorelbine]].<ref name="Clegg">{{cite journal | last =Clegg | first =A | coauthors =Scott DA, Hewitson P et al. | title =Clinical and cost effectiveness of paclitaxel, docetaxel, gemcitabine, and vinorelbine in non-small cell lung cancer: a systematic review |journal =Thorax | volume =57 | issue =1 | pages =20–28 | publisher =BMJ Publishing Group Ltd | date =Jan 2002 | pmid =11809985}}</ref> [[Bevacizumab]] improves results in non-squamous cancers treated with paclitaxel and carboplatin in patients less than 70 years old who have reasonable general performance status. <ref>{{cite journal |doi=10.1056/NEJMoa061884 |author=Sandler A, Gray R, Perry MC, et al. |title=Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer |journal=[[N Engl J Med]]|year=2006 |volume=355 |issue=24 |pages=2542–50 |pmid=17167137}}</ref> Bronchoalveolar carcinoma is a subtype of non-small cell lung carcinoma that may respond to [[gefitinib]]<ref>{{cite journal |doi=10.1200/JCO.2005.04.9890 |author=West HL, Franklin WA, McCoy J, et al. |title=Gefitinib therapy in advanced brochoalveolar carcinoma.  Southwest Oncology Group study S0126 |journal=[[J Clin Oncol]] |year=2006 |volume=24 |issue=12 |pages=1807–13 |pmid=16622257}}</ref> and [[erlotinib]].<ref>{{cite journal|doi=10.1200/JCO.2007.13.0062 |author=Miller VA, Riely GJ, Zakowski MF, et al. |title=Molecular characteristics of bronchoalveolar carcinoma and adenocarcinoma, brochoalveolar carcinoma subtype, predict response to erlotinib |journal=[[J Clin Oncol]] |year=2008|volume=26 |issue=9 |pages=1472–8 |pmid=18349398}}</ref>
====Concurrent Chemotherapy and Radiation Therapy Followed by Chemotherapy====
*[[Paclitaxel]] 45 - 50 mg/m² weekly AND [[carboplatin]] AUC 2 WITH concurrent [[Chest|thoracic]] [[radiation therapy]] FOLLOWED by 2 cycles of [[paclitaxel]] 200 mg/m² and [[carboplatin]] AUC 6 <ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>
*[[Cisplatin]] 50 mg/m² on days 1, 8, 29, and 36 AND [[etoposide]] 50 mg/m² days 1 - 5, 29 - 33 WITH concurrent [[Chest|thoracic]] [[radiation therapy]] FOLLOWED by [[cisplatin]] 50 mg/m² and [[etoposide]] 50 mg/m² x 2


Testing for the molecular genetic subtype of non-small cell lung cancer may be of assistance in selecting the most appropriate initial therapy<ref>{{cite journal |author=Aggarwal C et al. |title=Biomarkers with predictive and prognostic function in non-small cell lung cancer: ready for prime time? |journal=[[J Natl Compr Canc Netw]] |year=2010 |volume=8 |pages=822–32}}</ref> For example, mutation of the epidermal growth factor receptor gene<ref>{{cite journal |doi=10.1056/NEJMoa0904554 |last1=Rosell |first1=R|last2=Moran |first2=T |last3=Queralt |first3=C |last4=Porta |first4=R |last5=Cardenal |first5=F |last6=Camps |first6=C |last7=Majem|first7=M |last8=Lopez-Vivanco |first8=G |last9=Isla |first9=D |title=Screening for epidermal growth factor receptor mutations in lung cancer |journal=[[N Engl J Med]] |year=2009 |volume=361 |issue=10 |pages=958–67 |pmid=19692684}}</ref> may predict whether initial treatment with a specific inhibitor or with chemotherapy is more advantageous.<ref>{{cite journal |doi=10.1056/NEJMoa0810699|author=Mok TS et al. |title=Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma |journal=[[N Engl J Med]] |year=2009|volume=361 |issue=10 |pages=947–57 |pmid=19692680}}</ref> 
===Chemotherapy for Non Small Cell Lung Cancer===


Maintenance therapy in advanced non-small cell lung cancer refers to continuing treatment after an initial response to therapy.<ref>{{cite journal |author=Eaton KD, Martins RG |title=Maintenance chemotherapy in non-small cell lung cancer |journal=[[J Natl Compr Canc Netw]] |date=2010 Jul |volume=8 |issue=7 |pages=815–21 |pmid=20679540}}</ref> Switch maintenance changes to different medications than the initial therapy and can use [[pemetrexed]],<ref>{{cite journal |doi=10.1016/S0140-6736(09)61497-5|author=Ciuleanu T, Brodowicz T, Zielinski C, et al. |title=Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study |journal=[[Lancet]] |year=2009|volume=374 |pages=1432–40}}</ref> erlotinib,<ref>{{cite journal |doi=10.1016/S1470-2045(10)70112-1 |author=Cappuzzo F, Ciuleanu T, Stelmakh L, et al. |title=Erlotinib as maintenance treatment in advanced non-small-cell lung cancer: a multicentre, randomised, placebo-controlled phase 3 study |journal=[[Lancet|Lancet Oncol]] |year=2010 |volume=11 |pages=521–9}}</ref> and [[docetaxel]],<ref>{{cite journal |doi=10.1200/JCO.2008.17.1405 |author=Fidias PM, Dakhil SR, Lyss AP, et al. |title=Phase III study of immediate compared with delayed docetaxel after front-line therapy with gemcitabine plus carboplatin in advanced non-small-cell lung cancer |journal=[[J Clin Oncol]] |year=2009 |volume=27 |issue=4 |pages=591–8 |pmid=19075278}}</ref> although pemetrexed is only used in non-squamous NSCLC.<ref>{{cite journal |doi=10.1016/j.lungcan.2009.06.006 |author=Rossi A, Ricciardi S, Maione P, de Marinis F, Gridelli C |journal=[[Lung Cancer (journal)|Lung Cancer]] |year=2009 |volume=66 |issue=2 |pages=141–9 |title=Pemetrexed in the treatment of advanced non-squamous lung cancer |pmid=19577816}}</ref>
====Chemotherapy as Primary or Adjuvant Therapy<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>====
'''Limited Stage (Maximum of 4 - 6 cycles):'''
*[[Cisplatin]] 60 mg/m² day 1 AND [[etoposide]] 120 mg/m² days 1, 2, 31
*[[Cisplatin]] 80 mg/m² day 1 AND [[etoposide]] 100 mg/m² days 1, 2, 32
*[[Carboplatin]] AUC 5 - 6 day 1 AND [[etoposide]] 100 mg/m² days 1, 2, 33


==== Adjuvant chemotherapy for non-small cell lung carcinoma====
'''Extensive Stage (Maximum of 4 - 6 cycles):'''
*[[Cisplatin]] 75 mg/m² day 1 AND [[etoposide]] 100 mg/m² days 1, 2, 3
*[[Cisplatin]] 80 mg/m² day 1 AND [[etoposide]] 80 mg/m² days 1, 2, 3
*[[Cisplatin]] 25 mg/m² days 1, 2, 3 AND [[etoposide]] 100 mg/m² days 1, 2, 3
*[[Carboplatin]] AUC 5 - 6 day 1 AND [[etoposide]] 100 mg/m² days 1, 2, 3
*[[Cisplatin]] 60 mg/m² day 1 AND [[irinotecan]] 60 mg/m² days 1, 8, 15
*[[Cisplatin]] 30 mg/m² AND [[irinotecan]] 65 mg/m² days 1, 89
*[[Carboplatin]] AUC 5 day 1 and [[irinotecan]] 50 mg/m² days 1, 8, 15


[[Adjuvant chemotherapy]] refers to the use of chemotherapy after surgery to improve the outcome. During surgery, samples are taken from the [[lymph node]]s. If these samples contain cancer, then the patient has stage II or III disease. In this situation, adjuvant chemotherapy may improve survival by up to 15%.<ref name="Winton">{{cite journal | last =Winton | first =T | coauthors =Livingston R, Johnson D et al. | title =Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer | journal =New England Journal of Medicine | volume =352 | issue =25 | pages =2589–2597 | publisher =Massachusetts Medical Society | date =Jun 2005| pmid =15972865 }}</ref><ref name="Douillard">{{cite journal | last =Douillard | first =JY | coauthors =Rosell R, De Lena M et al.| title =Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung (Adjuvant Navelbine International Trialist Association <nowiki>[ANITA]</nowiki>): a randomised controlled trial | journal =Lancet Oncology | volume =7 | issue =9 | pages =719–727 | publisher =Elsevier | date =Sep 2006 | pmid =16945766 }}</ref> Standard practice is to offer platinum-based chemotherapy (including either cisplatin or carboplatin).<ref name="Tsuboi">{{cite journal |last =Tsuboi | first =M | coauthors =Ohira T, Saji H et al. | title =The present status of postoperative adjuvant chemotherapy for completely resected non-small cell lung cancer | journal = Ann Thorac Cardiovasc Surg | volume =13 | issue =2 | pages =73–77 | date =Apr 2007 | url =http://www.atcs.jp/pdf/2007_13_2/73.pdf | format = PDF | pmid =17505412 | accessdate =2007-08-14 }}</ref>  
====Subsequent Chemotherapy (Relapse < 2 - 3 Months)====
*[[Paclitaxel]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>
*[[Docetaxel]]
*[[Topotecan]]
*[[Irinotecan]]
*[[Temozolomide]]
*[[Gemcitabine]]
*[[Ifosfamide]]
*[[Bendamustine]]


Adjuvant chemotherapy for patients with stage IB cancer is controversial as clinical trials have not clearly demonstrated a survival benefit.<ref name="Horn">{{cite journal | last =Horn | first =L | coauthors = Sandler AB, Putnam JB Jr, Johnson DH | title =The rationale for adjuvant chemotherapy in stage I non-small cell lung cancer | journal =Journal of Thoracic Oncology | volume =2 |issue =5 | pages =377–383 | date =May 2007 | pmid =17473651 }}</ref><ref name="Wakelee">{{cite journal | last =Wakelee | first =HA |coauthors =Schiller JH, Gandara DR | title =Current status of adjuvant chemotherapy for stage IB non-small-cell lung cancer: implications for the New Intergroup Trial | journal =Clinical Lung Cancer | volume =8 | issue =1 | pages =18–21 | publisher =Cancer Information Group | date =Jul 2006 | pmid =16870041 }}</ref> Trials of preoperative chemotherapy ([[neoadjuvant chemotherapy]]) in resectable non-small cell lung carcinoma have been inconclusive.<ref name="Clinical evidence">{{cite book | last =BMJ | authorlink =British Medical Journal | title =Clinical Evidence Concise | publisher =BMJ Publishing Group | date =Dec 2005 | pages =486–488 |isbn =1-905545-00-2 | issn=1475-9225 }}</ref>
====Subsequent Chemotherapy (Relapse > 2 - 3 Months up to 6 Months)====
*[[Topotecan]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>
*[[Paclitaxel]]
*[[Docetaxel]]
*[[Irinotecan]]
*[[Gemcitabine]]
*[[Vinorelbine]]
*[[Oral]] [[etoposide]]
*[[Temozolomide]]
*[[Cyclophosphamide]]/[[doxorubicin]]/[[vincristine]]
*[[Bendamustine]]
 
====Subsequent Chemotherapy (Relapse > 6 Months)====
*Original regimen<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>
 
===Targeted Therapy===
 
* Targeted [[therapy]] treats selected lung cancers or is combined with [[chemotherapy]].
* It is less likely to harm normal [[Cell (biology)|cells]] compared to [[chemotherapy]].
 
==== The table below summarizes the targeted [[therapy]] drugs' [[mechanism of action]] and common [[Adverse effect (medicine)|side effects]]: <ref>http://www.nccn.org/patients/guidelines/nscl/#51/z</ref> ====
{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}}
 
| style="background:#f0f0f0;" align="center" |'''Drug'''
 
| style="background:#f0f0f0;" align="center" |'''Mechanism of Action'''
 
| style="background:#f0f0f0;" align="center" |'''Common Side Effects'''
 
|-
 
! Afatinib
|
* Blocks the signals from [[EGFR]] to prevent [[cell growth]]
|
* [[Diarrhea]], [[skin]] problems, [[mouth sores]], and [[lack of appetite]]
 
|-
 
! Bevacizumab
|
* Stops the [[growth]] of new [[Blood vessel|blood vessels]]
|
* [[Diarrhea]], [[Hypertension|high blood pressure]], [[headache]], [[fatigue]], and [[mouth sores]]
 
|-
 
! Cetuximab
|
* Attaches to [[EGFR]] to prevent [[cell growth]]
|
* [[Rash|Skin rash]], [[fatigue]], and [[weakness]]
 
|-
 
! Crizotinib
|
* Block the signals from [[anaplastic lymphoma kinase]] to prevent [[cell growth]]
|
* [[Lack of appetite]], [[nausea]], [[vomiting]], [[diarrhea]], [[Visual disturbance|visual defects]], and flu-like symptoms
 
|-
 
! Erlotinib hydrocholoride
|
* Blocks the signals from [[EGFR]] to prevent [[cell growth]]
|
* [[Rash|Skin rash]] on [[face]], [[neck]], or [[trunk]] within the first 2 weeks of treatment, [[diarrhea]], [[fatigue]], [[lack of appetite]], and [[nausea]]
 
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saarah T. Alkhairy M.D

Overview

Medical therapy for lung cancer consists of radiation therapy, chemotherapy, and targeted therapy.

Medical Therapy

  • The table below summarizes the treatment for each stage of lung cancer for those who either refuse or unable to tolerate surgery.
Stage Treatment
I
II (T2a, N0 OR T3, N0)
II (T1a, N1 OR T1b, N1 OR T2a, N1 OR T2b, N1)
III
  • The algorithm below demonstrates a treatment protocol for patients with stage I who can tolerate surgery: [1].


  • The algorithm below demonstrates a treatment protocol for patients with stage II without invasion who can tolerate surgery: [2]

  • The algorithm below demonstrates a treatment protocol for patients with stage II with invasion who can tolerate surgery: [3]

  • The algorithm below demonstrates a treatment protocol for patients with stage III without invasion who can tolerate surgery: [4][5]

  • The algorithm below demonstrates a treatment protocol for patients with stage III with invasion who can tolerate surgery: [6][7]
    • 0: Fully active
    • 1: Self-care activities but unable to do hard physical work
    • 2: Self-care activities but unable to do any work
    • 3: Unable to do any self-care activities or any work
    • 4: Fully disabled

Surgery

  • To learn about the surgical approach to lung cancer, click here.

Radiation Therapy

1. External Beam Radiation Therapy (EBRT)

  • This is more commonly used
  • The body receives radiation from an outside machine
  • The radiation is given in a series of sessions for about 8 weeks

2. Internal Radiation Therapy (Brachytherapy)

  • This approach involves placing a radioactive object in or near the tumor
  • This can shrink an airway blocking tumor

Chemotherapy for Non Small Cell Lung Cancer

Chemotherapy Regimens as Neo-adjuvant and Adjuvant Therapy

  • Cisplatin 50 mg/m² days 1 and 8 AND vinorelbine 25 mg/m² days 1, 8, 15, 22, every 28 days for 4 cycles[10]
  • Cisplatin 100 mg/m² day 1 AND vinorelbine 30 mg/m² days 1, 8, 15, 22, every 28 days for 4 cycles
  • Cisplatin 75 - 80 mg/m² day 1 AND vinorelbine 25 - 30 mg/m² days 1 + 8, every 21 days for 4 cycles
  • Cisplatin 100 mg/m² day 1 AND etoposide 100 mg/m² days 1 - 3, every 28 days for 4 cycles
  • Cisplatin 80 mg/m² days 1, 22, 43, 64 AND vinblastine 4 mg/m² days 1, 8, 15, 22, 29 then every 2 weeks after day 43, every 21 days for 4 cycles
  • Cisplatin 75 mg/m² day 1 AND gemcitabine 1250 mg/m² days 1, 8, every 21 days for 4 cycles
  • Cisplatin 75 mg/m² day 1 AND docetaxel 75 mg/m² day 1, every 21 days for 4 cycles
  • Cisplatin 75 mg/m² day 1 AND pemetrexed 500 mg/m² day 1 for non-squamous (without specific histologic sub-type), every 21 days for 4 cycles

Chemotherapy Regimens for Patients with Comorbidities or Patients Not Able to Tolerate Cisplatin

Concurrent Chemotherapy and Radiation Therapy Regimens

Sequential Chemotherapy and Radiation Therapy Regimens

Concurrent Chemotherapy and Radiation Therapy Followed by Chemotherapy

Chemotherapy for Non Small Cell Lung Cancer

Chemotherapy as Primary or Adjuvant Therapy[15]

Limited Stage (Maximum of 4 - 6 cycles):

Extensive Stage (Maximum of 4 - 6 cycles):

Subsequent Chemotherapy (Relapse < 2 - 3 Months)

Subsequent Chemotherapy (Relapse > 2 - 3 Months up to 6 Months)

Subsequent Chemotherapy (Relapse > 6 Months)

  • Original regimen[18]

Targeted Therapy

The table below summarizes the targeted therapy drugs' mechanism of action and common side effects: [19]

Drug Mechanism of Action Common Side Effects
Afatinib
Bevacizumab
Cetuximab
Crizotinib
Erlotinib hydrocholoride

References

  1. ↑ http://www.nccn.org/patients/guidelines/nscl/#56/z
  2. ↑ http://www.nccn.org/patients/guidelines/nscl/#58/z
  3. ↑ http://www.nccn.org/patients/guidelines/nscl/#61/z
  4. ↑ http://www.nccn.org/patients/guidelines/nscl/#63/z
  5. ↑ http://www.nccn.org/patients/guidelines/nscl/#64/z
  6. ↑ http://www.nccn.org/patients/guidelines/nscl/#66/z
  7. ↑ http://www.nccn.org/patients/guidelines/nscl/#67/z
  8. ↑ http://www.nccn.org/patients/guidelines/nscl/#72/z
  9. ↑ http://www.nccn.org/patients/guidelines/nscl/#71/z
  10. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  11. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  12. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  13. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  14. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  15. ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
  16. ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
  17. ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
  18. ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
  19. ↑ http://www.nccn.org/patients/guidelines/nscl/#51/z

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