Non small cell lung cancer medical therapy: Difference between revisions
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===Positive sensitizing EGRF mutation=== | ===Positive sensitizing EGRF mutation=== | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | E01 | | | | | | | | |E01=Was the mutation discovered before the initiation of first line therapy?}} | {{familytree | | | | | | | | | | | | | | | | | E01 | | | | | | | | |E01=Was the mutation discovered before the initiation of first line therapy?}} | ||
{{familytree | | | | |,|-|-|^|-|-|.| | |}} | {{familytree | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | |}} | ||
{{familytree | | | | F01 | | | | F02 | | |F01=Yes|F02=No|}} | {{familytree | | | | | | | | | | | | | | F01 | | | | F02 | | |F01=Yes|F02=No|}} | ||
{{familytree | | | | |!| | | | | |!| | | }} | {{familytree | | | | | | | | | | | | | | |!| | | | | |!| | | }} | ||
{{familytree | | | | G01 | | | | G02 | | |G01=Initiate erlotinib or afatinib|G02=Suspend or complete chemotherapy and initiate erlotinib or afatinib<br>'''OR'''<br> Add erlotinib or afatinib to chemotherapy regimen|}} | {{familytree | | | | | | | | | | | | | | G01 | | | | G02 | | |G01=Initiate erlotinib or afatinib|G02=Suspend or complete chemotherapy and initiate erlotinib or afatinib<br>'''OR'''<br> Add erlotinib or afatinib to chemotherapy regimen|}} | ||
{{familytree | | | | |`|-|-|v|-|-|'| | | | |}} | {{familytree | | | | | | | | | | | | | | |`|-|-|v|-|-|'| | | | |}} | ||
{{familytree | | | | | | | H01 | | | | | | | | |H01=Did the tumor progressed or responded?|}} | {{familytree | | | | | | | | | | | | | | | | | H01 | | | | | | | | |H01=Did the tumor progressed or responded?|}} | ||
{{familytree | | | | |,|-|-|^|-|-|.| | | | }} | {{familytree | | | | | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | | }} | ||
{{familytree | | | | I01 | | | | I02 | | | |I01=Tumor progression|I02=Positive response or stable tumor}} | {{familytree | | | | | | | | | | | | I01 | | | | | | | | I02 | | | |I01=Tumor progression|I02=Positive response or stable tumor}} | ||
{{familytree | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | | | |}} | |||
{{familytree | | | | | | | | J01 | | | | | | J02 | | | | | | | | | |J01=Symptomatic disease|J02=Asymptomatic disease}} | |||
{{familytree | | | | |,|-|-|-|^|-|-|-|.| | | | |!| | | | | | | | | | | |}} | |||
{{familytree | | | | K01 | | | | | | K02 | | | K03 | | | | | | | | |K01=Systemic metastasis|K02=Brain metastasis|K03=Continue treatment}} | |||
{{familytree | | |,|-|^|-|.| | | |,|-|^|-|.| | | | | | | | | | | | | |}} | |||
{{familytree | | L01 | | L02 | | L03 | | L04 | | | | | | | | | |L01=Multiple metastasis|L02=Single metastasis|L03=Multiple metastasis|L04=Single metastasis}} | |||
{{familytree | | |!| | | |!| | | |!| | | |!| | | | | | | | | | |}} | |||
{{familytree | | M01 | | M02 | | M03 | | M04 | | | | | | | | | |M01=Continue treatment, consider local therapy|M02=Continue treatment, consider whole brain radiation therapy|M03=Continue treatment, consider local therapy|M04=Consider platinum doublet <br>AND/OR<br> Bevacizumab <br>AND/OR<br> Erlotinib}} | |||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 21:07, 13 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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Non small cell lung cancer medical therapy On the Web |
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American Roentgen Ray Society Images of Non small cell lung cancer medical therapy |
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Directions to Hospitals Treating Small cell carcinoma of the lung |
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Risk calculators and risk factors for Non small cell lung cancer medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
Metastatic adenocarcinoma
Positive sensitizing EGRF mutation
| Was the mutation discovered before the initiation of first line therapy? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Initiate erlotinib or afatinib | Suspend or complete chemotherapy and initiate erlotinib or afatinib OR Add erlotinib or afatinib to chemotherapy regimen | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Did the tumor progressed or responded? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tumor progression | Positive response or stable tumor | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Symptomatic disease | Asymptomatic disease | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Systemic metastasis | Brain metastasis | Continue treatment | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Multiple metastasis | Single metastasis | Multiple metastasis | Single metastasis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Continue treatment, consider local therapy | Continue treatment, consider whole brain radiation therapy | Continue treatment, consider local therapy | Consider platinum doublet AND/OR Bevacizumab AND/OR Erlotinib | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Positive ALK mutation
| Was the mutation discovered before the initiation of first line therapy? | |||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Initiate crizotinib | Suspend or complete chemotherapy and initiate crizotinib | ||||||||||||||||||||||||||||||||||||||||||
| Did the tumor progressed or responded? | |||||||||||||||||||||||||||||||||||||||||||
| Tumor progression | Positive response or stable tumor | ||||||||||||||||||||||||||||||||||||||||||
Negative EGRF and ALK or unknown mutation
| What is the performance status (PS) of the patient? | |||||||||||||||||||||||||||||||||||||||||||
| 0-1 | 2 | 3-4 | |||||||||||||||||||||||||||||||||||||||||
| Doublet chemotherapy OR Bevacizumab + Chemotherapy OR Cetuximab/vinorelbine/cisplatin | Chemotherapy | Suportive care | |||||||||||||||||||||||||||||||||||||||||
| What was the tumor response to the treatment? | |||||||||||||||||||||||||||||||||||||||||||
| Progression | Positive response or stable tumor | ||||||||||||||||||||||||||||||||||||||||||
| Administer 4-6 cycles and assess progression of the disease | |||||||||||||||||||||||||||||||||||||||||||
| PS 0-2 | PS 3-4 | Tumor progression | Positive response or stable tumor | ||||||||||||||||||||||||||||||||||||||||
| Initiate docetaxel or pemetrexed or erlotinib or gemcitabine | Provide suportive care | Initiate docetaxel or pemetrexed or erlotinib or gemcitabine | Continuation mantainance (cetuximab or gemcitabine) OR Switch mantainance (erlotinib or decetaxel) OR Close observation | ||||||||||||||||||||||||||||||||||||||||