Lung cancer medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, Cafer Zorkun, M.D., Ph.D. [2]

Overview

The use chemotherapy and the specific regimen used depends on the tumor type.

Medical Therapy

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

Surgery

To view the surgery of lung cancer, click here

Radiation Therapy

Radiation therapy can be given with either one of two methods:

• 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

• Internal Radiation Therapy (brachytherapy)

• This therapy involves placing a radioactive object in or near the tumor
• This can shrink a tumor that blocks the airway

• Possible side effects include the following:

• Dry, sore, painful skin
• Hair loss
• Swelling of the lungs or esophagus
• Fatigue
• Loss of appetite

Chemotherapy for Non Small Cell Lung Cancer

Chemotherapy Regimens for Neoadjuvant 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
• 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 wks 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 nonsquamous (without specific histologic subtype), every 21 days for 4 cycles

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

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 thoracic radiation therapy
• Cisplatin 100 mg/m2 days 1 and 29 AND vinblastine 5 mg/m2/weekly x 5 WITH concurrent 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 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 thoracic radiation therapy

Sequential Chemotherapy and Radiation Therapy Regimens

• 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
• 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 thoracic radiation therapy

Concurrent Chemotherapy and Radiation Therapy Followed by Chemotherapy

• Paclitaxel 45-50 mg/m2 weekly AND carboplatin AUC 2 WITH concurrent thoracic radiation therapy FOLLOWED by 2 cycles of paclitaxel 200 mg/m2 and carboplatin AUC 6
• Cisplatin 50 mg/m2 on days 1, 8, 29, and 36 AND etoposide 50 mg/m2 days 1-5, 29-33 WITH concurrent thoracic radiation therapy FOLLOWED by cisplatin 50 mg/m2 and etoposide 50 mg/m2 x 2

Targeted Therapy

Drug	Mechanism of Action	Common Side Effects
Afatinib	Blocks the signals from EGFRs to prevent cell growth	Diarrhea, skin problems, mouth sores, and lack of appetite
Bevacizumab	Stops the growth of new blood vessels	Diarrhea, high blood pressure, headache, fatigue, and mouth sores
Cetuximab	Attaches to EGFRs to prevent cell growth	Skin rash, fatigue, and weakness
Crizotinib	Block the signals from ALKs to prevent cell growth	Lack of appetite, nausea, vomiting, diarrhea, visual defects, and flu-like symptoms
Erlotinib hydrocholoride	Blocks the signals from EGFRs to prevent cell growth	Skin rash on face, neck, or trench within the first 2 weeks of treatment, diarrhea, fatigue, lack of appetite, and nausea

References

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