Non small cell lung cancer chemotherapy: Difference between revisions
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Chemotherapeutic regimens based on platinum agents have demonstrated longer survival rates, better symptom control and higher quality of life when compared with best supportive care. | Chemotherapeutic regimens based on platinum agents have demonstrated longer survival rates, better symptom control and higher quality of life when compared with best supportive care. | ||
==Chemotherapeutic | ==Chemotherapeutic Regimens== | ||
Shown below is a table depicting the different choices of regimens for the initial or adjuvant chemotherapy of patients with non-small cell lung cancer. The list of regimens has been adapted from the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | Shown below is a table depicting the different choices of regimens for the initial or adjuvant chemotherapy of patients with non-small cell lung cancer. The list of regimens has been adapted from the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | ||
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===Alternative Regimen | ===Alternative Regimen=== | ||
Paclitaxel 200 mg/m<sup>2</sup> on day 1 + carboplatin area under the concentration (AUC) 6 on day 1 and then every 21 days.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | Paclitaxel 200 mg/m<sup>2</sup> on day 1 + carboplatin area under the concentration (AUC) 6 on day 1 and then every 21 days.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | ||
==Chemotherapy with | ==Chemotherapy with Radiation Therapy Regimens== | ||
===Chemotherapy plus Radiation Therapy=== | ===Chemotherapy plus Radiation Therapy=== | ||
The list bellow show the options for concomitant [[chemotherapy]] plus [[radiation therapy]] based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | The list bellow show the options for concomitant [[chemotherapy]] plus [[radiation therapy]] based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref> | ||
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* [[Cisplatin]]50 mg/m<sup>2</sup> on days 1, 8, 29 and 36 + [[etoposide]] 50 mg/m<sup>2</sup> through day 1 to 5 and then 29 to 33 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[cisplatin]] 50 mg/m<sup>2</sup> + [[etoposide]] 50 mg/m<sup>2</sup> to a total of 2 cycles. | * [[Cisplatin]]50 mg/m<sup>2</sup> on days 1, 8, 29 and 36 + [[etoposide]] 50 mg/m<sup>2</sup> through day 1 to 5 and then 29 to 33 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[cisplatin]] 50 mg/m<sup>2</sup> + [[etoposide]] 50 mg/m<sup>2</sup> to a total of 2 cycles. | ||
* [[Paclitaxel]] 45 to 50 mg/m<sup>2</sup> once a week + carboplatin AUC 2 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[Paclitaxel]] 200 mg/m<sup>2</sup> + carboplatin AUC 6 to a total of 2 cycles. | * [[Paclitaxel]] 45 to 50 mg/m<sup>2</sup> once a week + carboplatin AUC 2 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[Paclitaxel]] 200 mg/m<sup>2</sup> + carboplatin AUC 6 to a total of 2 cycles. | ||
==Treatment Management by Stage== | |||
*The table below summarizes the different standard treatment options according to the TNM criteria for non-small cell lung cancer | |||
{|style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align=center | |||
!style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" colspan="3"|{{fontcolor|#FFF|'''Standard Treatment Options'''<br><SMALL>Adapted from Non-Small Cell Lung Cancer Treatment (PDQ® 2016) <ref name="PDQ"> PDQ Adult Treatment Editorial Board. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032637/ Accessed on February 22, 2016 </ref></SMALL>}} | |||
|+ | |||
|- | |||
! style="background: #4479BA; width: 50px;" | {{fontcolor|#FFF|'''Stage (TNM criteria)'''}} | |||
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|'''Standard Treatment Options'''}} | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Occult''' | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
* Surgery | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stage 0''' | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
*Surgery | |||
*Endobronchial therapies | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stages IA and IB''' | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
*Surgery | |||
*Radiation therapy | |||
*IB, if the tumor is >4cm, surgery and chemotherapy | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|'''Stages IIA and IIB''' | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
*Surgery | |||
*Neoadjuvant chemotherapy | |||
*Adjuvant chemotherapy | |||
*Radiation therapy | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stage IIIA''' | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
'''Resected or resectable disease''' | |||
*Surgery | |||
*Neoadjuvant therapy | |||
*Adjuvant therapy | |||
'''Unresectable disease''' | |||
*Radiation therapy | |||
*Chemoradiation therapy | |||
'''Superior sulcus tumors ''' | |||
*Radiation therapy alone | |||
*Radiation therapy and surgery | |||
*Concurrent chemotherapy with radiation therapy and surgery | |||
*Surgery alone (for selected patients) | |||
'''Tumors that invade the chest wall''' | |||
*Surgery | |||
*Surgery and radiation therapy | |||
*Radiation therapy alone | |||
*Chemotherapy combined with radiation therapy and/or surgery | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stage IIIB''' | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
*Sequential or concurrent chemotherapy and radiation therapy | |||
*Chemotherapy followed by surgery (for selected patients) | |||
*Radiation therapy alone | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stage IV''' | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
*Cytotoxic combination chemotherapy (first line) | |||
*Combination chemotherapy with bevacizumab or cetuximab | |||
*EGFR tyrosine kinase inhibitors (first line) | |||
*EML4-ALK inhibitors in patients with EML-ALK translocations | |||
*Immune checkpoint inhibition with nivolumab for selected patients with squamous or nonsquamous metastatic | |||
Maintenance therapy following first-line chemotherapy | |||
* Endobronchial laser therapy and/or brachytherapy (for obstructing lesions) | |||
* External-beam radiation therapy (primarily for palliation of local symptomatic tumor growth) | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Recurrent''' | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
*Radiation therapy (for palliation) | |||
*Chemotherapy or kinase inhibitors alone EGFR inhibitors in patients with/without EGFR mutations | |||
*EML4-ALK inhibitors in patients with EML-ALK translocations | |||
*Surgical resection of isolated cerebral metastasis (for highly selected patients) | |||
*Laser therapy or interstitial radiation therapy (for endobronchial lesions) | |||
*Stereotactic radiation surgery (for highly selected patients) | |||
|} | |||
==References== | ==References== | ||
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[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Lung cancer]] | [[Category:Lung cancer]] | ||
Revision as of 20:50, 1 March 2016
Non Small Cell Lung Cancer Microchapters |
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Risk calculators and risk factors for Non small cell lung cancer chemotherapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
Chemotherapeutic regimens based on platinum agents have demonstrated longer survival rates, better symptom control and higher quality of life when compared with best supportive care.
Chemotherapeutic Regimens
Shown below is a table depicting the different choices of regimens for the initial or adjuvant chemotherapy of patients with non-small cell lung cancer. The list of regimens has been adapted from the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
Cisplatin Based Therapy
Agent | Recommended regimen |
---|---|
Cisplatin 50 mg/m2 + vinorelbine 25 mg/m2 | Cisplatin on days 1 and 8, vinorelbine on days 1, 8, 15, 22 and every 28 days to a total of 4 cycles |
Cisplatin 100 mg/m2 + vinorelbine 30 mg/m2 | Cisplatin on day 1, vinorelbine on days 1, 8, 15, 22 and every 28 days to a total of 4 cycles |
Cisplatin 75-80 mg/m2 + vinorelbine 25-50 mg/m2 | Cisplatin on day 1, vinorelbine on days 1, 8 and every 21 days to a total of 4 cycles |
Cisplatin 80 mg/m2 + vinorelbine 4 mg/m2 | Cisplatin on days 1, 22, 43, 64, then every 21 days to a total of 4 cycles, vinorelbine on days 1, 8, 15, 22, 29, every 2 weeks after day 43 until the completion of cisplatin treatmet |
Cisplatin 100 mg/m2 + etoposide 100 mg/m2 | Cisplatin on day 1, etoposide through days 1 to 3 and every 28 days to a total of 4 cycles |
Cisplatin 75 mg/m2 + gemcitabine 1250 mg/m2 | Cisplatin on day 1, gemcitabine on days 1, 8 and every 21 days to a total of 4 cycles |
Cisplatin 75 mg/m2 + docetaxel 75 mg/m2 | Cisplatin on day 1, docetaxel on day 1 and every 21 days to a total of 4 cycles |
Cisplatin 50 mg/m2 + pemetrexed 500 mg/m2 | Cisplatin on day 1, pemetrexed on days 1 and every 21 days to a total of 4 cycles |
Alternative Regimen
Paclitaxel 200 mg/m2 on day 1 + carboplatin area under the concentration (AUC) 6 on day 1 and then every 21 days.[1]
Chemotherapy with Radiation Therapy Regimens
Chemotherapy plus Radiation Therapy
The list bellow show the options for concomitant chemotherapy plus radiation therapy based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
- Cisplatin 50 mg/m2 on days 1, 8, 29 and 36 + etoposide 50 mg/m2 through days 1 to 5 and then 29 to 33 + thoracic radiation therapy.
- Cisplatin 100 mg/m2 on days 1 and 29 + vinblastine 5 mg/m2 weekly for 5 weeks + thoracic radiation therapy.
- Cisplatin 75 mg/m2 on the first day + pemetrexed 500 mg/m2 on day 1 and then every 21 days to a total of 3 cycles + thoracic radiation therapy.
- Carboplatin AUC 5 on the first day + pemetrexed 500 mg/m2 on day 1 and then every 21 days to a total of 3 cycles + thoracic radiation therapy.
Chemotherapy Followed by Radiation Therapy
The list bellow show the options for chemotherapy followed by radiation therapy based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
- Cisplatin 100 mg/m2 on days 1 and 29 + vinblastine 5 mg/m2 per week on days 1, 8, 15, 22 and 29, then followed by thoracic radiation therapy.
- Paclitaxel 200 mg/m2 administered for 3 hours in the first day + carboplatin AUC 6 administered in 1 hour and then every 21 days to a total of 2 cycles followed by thoracic radiation therapy.
Chemotherapy plus Radiation Therapy, Followed by Chemotherapy
The list bellow show the options for concomitant chemotherapy plus radiation therapy followed by chemotherapy based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
- Cisplatin50 mg/m2 on days 1, 8, 29 and 36 + etoposide 50 mg/m2 through day 1 to 5 and then 29 to 33 + thoracic radiation therapy, then followed by cisplatin 50 mg/m2 + etoposide 50 mg/m2 to a total of 2 cycles.
- Paclitaxel 45 to 50 mg/m2 once a week + carboplatin AUC 2 + thoracic radiation therapy, then followed by Paclitaxel 200 mg/m2 + carboplatin AUC 6 to a total of 2 cycles.
Treatment Management by Stage
- The table below summarizes the different standard treatment options according to the TNM criteria for non-small cell lung cancer
Standard Treatment Options Adapted from Non-Small Cell Lung Cancer Treatment (PDQ® 2016) [2] |
||
---|---|---|
Stage (TNM criteria) | Standard Treatment Options | |
Occult |
| |
Stage 0 |
| |
Stages IA and IB |
| |
Stages IIA and IIB |
| |
Stage IIIA |
Resected or resectable disease
Unresectable disease
Superior sulcus tumors
Tumors that invade the chest wall
| |
Stage IIIB |
| |
Stage IV |
Maintenance therapy following first-line chemotherapy
| |
Recurrent |
|
References
- ↑ 1.0 1.1 1.2 1.3 1.4 http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf
- ↑ PDQ Adult Treatment Editorial Board. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032637/ Accessed on February 22, 2016