Non small cell lung cancer medical therapy: Difference between revisions
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|- | |+ '''Cisplatin based therapy'''<ref name="pmid14736927">{{cite journal| author=Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J et al.| title=Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 4 | pages= 351-60 | pmid=14736927 | doi=10.1056/NEJMoa031644 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14736927 }} </ref> | ||
! Agent !! Recommended regimen | ! Agent !! Recommended regimen | ||
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==References== | ==References== | ||
Revision as of 15:18, 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
The algorithms for the treatment of metastatic non small cell carcinoma of the lung are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
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 | |||||||||||||||||||||||||||||||||||||||||||||||||
Chemotherapeutic regimens
The table below is based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
| 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 50mg/m2 + pemetrexed 500 mg/m2 | Cisplatin on day 1, pemetrexed on days 1 and every 21 days to a total of 4 cycles |
References
- ↑ 1.0 1.1 "Non-Small Cell Lung Cancer NCCN-2014" (PDF). Retrieved 2014-06-16.
- ↑ Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J; et al. (2004). "Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer". N Engl J Med. 350 (4): 351–60. doi:10.1056/NEJMoa031644. PMID 14736927.