Small cell carcinoma of the lung medical therapy: Difference between revisions
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==Adjuvant Medical Therapy== | ==Adjuvant Medical Therapy== | ||
==Choices for Initial or Adjuvant Chemotherapy== | ==Choices for Initial or Adjuvant Chemotherapy== | ||
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|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Carboplatin]] AUC 5 (day 1) <br> PLUS <br> [[Irinotecan]] 50 mg/m<sup>2</sup> (day 1, 8, 15) | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |[[Carboplatin]] AUC 5 (day 1) <br> PLUS <br> [[Irinotecan]] 50 mg/m<sup>2</sup> (day 1, 8, 15) | ||
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==Therapy for Relapse or Palliative Therapy== | |||
===Choices for Chemotherapy for Relapse=== | |||
Among patients receiving chemotherapy for relapse, the involvement in clinical trials is encouraged. | |||
* If the relapse occurred less than 2-3 months following the initial treatment and the performance status is good (PS 0-2), the choices for chemotherapy include: [[docetaxel]], [[gemcitabine]], [[ifosfamide]], [[irinotecan]], [[paclitaxel]], [[temozolomide]], and [[topotecan]]. | |||
* If the relapse occurred more than 2-3 months but not later than 6 months following the initial treatment, the choices for chemotherapy include: Combination of [[cyclophosphamide]] and [[doxorubicin]] and [[vincristine]], [[docetaxel]], [[etoposide]], [[gemcitabine]], [[ifosfamide]], [[irinotecan]], [[paclitaxel]], [[temozolomide]], [[topotecan]], and [[vinorelbine]]. | |||
* If the relapse occurred more than 6 months following the initial treatment, the initial chemotherapy regimen should be repeated. | |||
==References== | ==References== | ||
Revision as of 13:07, 8 June 2014
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Small Cell Carcinoma of the Lung Microchapters |
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Differentiating Small Cell Carcinoma of the Lung from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Small cell carcinoma of the lung medical therapy On the Web |
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American Roentgen Ray Society Images of Small cell carcinoma of the lung medical therapy |
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Small cell carcinoma of the lung medical therapy in the news |
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Directions to Hospitals Treating Small cell carcinoma of the lung |
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Risk calculators and risk factors for Small cell carcinoma of the lung medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Patients with small cell carcinoma (SCC) of the lung have many treatment options. The selection depends on the stage of the tumor. The options are radiation therapy, chemotherapy, surgery, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.
Initial Medical Therapy
Limited Stage SCC
| Limited stage SCC | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Clinical stage T(1-2),N(0) | Limited stage in excess of T(1-2),N(0) | ||||||||||||||||||||||||||||||||||||||||||||||||||
| What is the statuses of the pathologic mediastinal staging AND operability of the patient? | What is the performance status of the patient? | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Negative pathologic mediastinal staging AND Patient is medically operable | Positive pathologic mediastinal staging OR Patient is medically operable | Good (PS 0-2) | Poor (PS 3-4) due to SCC | Poor (PS 3-4) not due to SCC | |||||||||||||||||||||||||||||||||||||||||||||||
| Lobectomy PLUS Lymph node dissection or sampling | What is the performance status of the patient? | Chemotherapy PLUS Thoracic radiation therapy | Chemotherapy WITH/WITHOUT Thoracic radiation therapy | Individualized treatment PLUS supportive care | |||||||||||||||||||||||||||||||||||||||||||||||
| What is the status of involvement of the lymph nodes? | Good (PS 0-2) | Poor (PS 3-4) due to SCC | Poor (PS 3-4) not due to SCC | ||||||||||||||||||||||||||||||||||||||||||||||||
| N0 | N+ | Chemotherapy PLUS Thoracic radiation therapy | Chemotherapy WITH/WITHOUT Thoracic radiation therapy | Individualized treatment PLUS supportive care | |||||||||||||||||||||||||||||||||||||||||||||||
| Chemotherapy | Chemotherapy PLUS Mediastinal radiotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||
Extensive Stage
| Extensive stage | |||||||||||||||||||||||||||||||||||||||||||||||
| Is there symptomatic localized metastasis OR brain metastasis? | |||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes, there is symptomatic localized metastasis | Yes, there is brain metastasis | |||||||||||||||||||||||||||||||||||||||||||||
| What is the performance status of the patient? | What metastasis related symptoms does the patient have? | Is the patient symptomatic? | |||||||||||||||||||||||||||||||||||||||||||||
| Good (PS 0-2) OR Poor (3-4) due to SCLC | Poor (3-4) not due to SCLC | Superior vena cava syndrome OR Lobar obstruction OR Bone metastasis | Spinal cord compression | Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Combination chemotherapy PLUS Supportive care | Individualized therapy PLUS Supportive care | Chemotherapy WITH/WITHOUT Radiation therapy to the sites of metastasis | Radiation therapy to the sites of metastasis THEN Chemotherapy (unless medical therapy is immediately necessary) | Whole brain radiation therapy THEN Chemotherapy (unless medical therapy is immediately necessary) | Chemotherapy THEN Whole brain radiation therapy | ||||||||||||||||||||||||||||||||||||||||||
| Is the patient at elevated risk for fracture? | |||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||
| Palliative external beam radiation therapy PLUS Orthopedic stabilization | No additional measures | ||||||||||||||||||||||||||||||||||||||||||||||
Adjuvant Medical Therapy
Choices for Initial or Adjuvant Chemotherapy
| Choices for initial or adjuvant chemotherapy (maximum number of cycles: 4-6) | |
| Limited stage SCLC | |
| Cisplatin 60 mg/m2 (day 1) PLUS Etoposide 120 mg/m2 (day 1, 2, 3) | |
| Cisplatin 80 mg/m2 (day 1) PLUS Etoposide 100 mg/m2 (day 1, 2, 3) | |
| Carboplatin AUC 5-6 (day 1) PLUS Etoposide 100 mg/m2 (day 1, 2, 3) | |
| Extensive stage SCLC | |
| Cisplatin 75 mg/m2 (day 1) PLUS Etoposide 100 mg/m2 (day 1, 2, 3) | |
| Cisplatin 80 mg/m2 (day 1) PLUS Etoposide 80 mg/m2 (day 1, 2, 3) | |
| Cisplatin 25 mg/m2 (day 1, 2, 3) PLUS Etoposide 100 mg/m2 (day 1, 2, 3) | |
| Carboplatin AUC 5-6 (day 1) PLUS Etoposide 100 mg/m2 (day 1, 2, 3) | |
| Cisplatin 60 mg/m2 (day 1) PLUS Irinotecan 60 mg/m2 (day 1, 8, 15) | |
| Cisplatin 30 mg/m2 (day 1) PLUS Irinotecan 65 mg/m2 (day 1, 8, 21) | |
| Carboplatin AUC 5 (day 1) PLUS Irinotecan 50 mg/m2 (day 1, 8, 15) | |
Therapy for Relapse or Palliative Therapy
Choices for Chemotherapy for Relapse
Among patients receiving chemotherapy for relapse, the involvement in clinical trials is encouraged.
- If the relapse occurred less than 2-3 months following the initial treatment and the performance status is good (PS 0-2), the choices for chemotherapy include: docetaxel, gemcitabine, ifosfamide, irinotecan, paclitaxel, temozolomide, and topotecan.
- If the relapse occurred more than 2-3 months but not later than 6 months following the initial treatment, the choices for chemotherapy include: Combination of cyclophosphamide and doxorubicin and vincristine, docetaxel, etoposide, gemcitabine, ifosfamide, irinotecan, paclitaxel, temozolomide, topotecan, and vinorelbine.
- If the relapse occurred more than 6 months following the initial treatment, the initial chemotherapy regimen should be repeated.