Non small cell lung cancer medical therapy: Difference between revisions
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{{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|}} | ||
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{{familytree | | | | K01 | | | | | | K02 | | | K03 | | | | | | | | |K01=Systemic metastasis|K02=Brain metastasis|K03=Continue treatment}} | {{familytree | | | | K01 | | | | | | K02 | | | K03 | | | | | | | | |K01=Systemic [[metastasis]]|K02=Brain [[metastasis]]|K03=Continue treatment}} | ||
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{{familytree | | L01 | | L02 | | L03 | | L04 | | | | | | | | | |L01=Multiple metastasis|L02=Single metastasis|L03=Multiple metastasis|L04=Single metastasis}} | {{familytree | | L01 | | L02 | | L03 | | L04 | | | | | | | | | |L01=Multiple [[metastasis]]|L02=Single [[metastasis]]|L03=Multiple [[metastasis]]|L04=Single [[metastasis]]}} | ||
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{{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>with or without<br> Bevacizumab <br>AND/OR<br> Erlotinib}} | {{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>with or without<br> Bevacizumab <br>AND/OR<br> Erlotinib}} | ||
Revision as of 13:46, 16 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 progress or respond? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 with or without 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 progress or respond? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Tumor progression | Positive response or stable tumor | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Symptomatic disease | Asymptomatic disease | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Systemic metastasis | Brain metastasis | Continue treatment or change to certinib according to the degree of disease | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | Initiate certinib OR Consider platinum doublet with or without Bevacizumab AND/OR Erlotinib | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | ||||||||||||||||||||||||||||||||||||||||||||||
| Initiate docetaxel or pemetrexed or erlotinib or gemcitabine | |||||||||||||||||||||||||||||||||||||||||||||||||
Metastatic squamous cell carcinoma
| What is the performance status (PS) of the patient? | |||||||||||||||||||||||||||||||||||||||||||||||||
| 0-1 | 2 | 3-4 | |||||||||||||||||||||||||||||||||||||||||||||||
| Doublet 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 erlotinib or gemcitabine | Provide suportive care | Initiate docetaxel or erlotinib or gemcitabine | Continuation mantainance (cetuximab or gemcitabine) OR Switch mantainance (erlotinib or decetaxel) OR Close observation | ||||||||||||||||||||||||||||||||||||||||||||||
| Initiate docetaxel or erlotinib or gemcitabine | |||||||||||||||||||||||||||||||||||||||||||||||||