Non small cell lung cancer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2] Maria Fernanda Villarreal, M.D. [3]
Overview
Chemotherapy is indicated for non-small cell lung cancer stage (IB, II, and III) as adjuvant therapy. The predominant therapy for non-small cell lung cancer is surgical resection. Chemotherapy and chemoradiation may be required upon histological subtype of non-small cell lung cancer, location, size, and lymph node involvement. Commonly used chemotherapeutic agents, include: gemcitabine, paclitaxel, docetaxel, pemetrexed, etoposide or vinorelbine.
Medical Therapy
Initial medical therapy for patients with non-small cell lung cancer will depend on tumor histology and molecular testing (presence of genetic mutations).[1]
- If the tumor demonstrates the absence of genetic mutation or is a squamous-cell tumor, the treatment of choice will be platinum-based chemotherapy.
- If the tumor is a non-squamous cell tumor and positive for molecular testing, the treatment of choice will be with a specific-inhibitor such as:
- EGFR mutation (erlotinib, gefitinib, afatinib)
- ALK mutation (crizotinib)
- ROS1 mutation (crizotinib)
- Targeted therapy agents include erlotinib, crizotinib, gefitinib,afatinib, and denosumab
- Targeted agents usually inhibit tyrosine kinase at the epidermal growth factor receptor
- Chemotherapy is indicated as adjuvant for stage IB, II, and III non-small cell lung cancer
- Platinum-based chemotherapy (cisplatin, carboplatin, etoposide, irinotecan) are the mainstay of treatment for non-small cell lung cancer
- Platinum-based chemotherapy consists of four to six cycles
- In patients with non-squamous histology, platinum-based chemotherapy may be supplemented by bevacizumab
- Other chemotherapy regimens may be an alternative for non-small cell lung cancer patients who are unable to tolerate a platinum-based chemotherapy. These include:
- Cyclophosphamide
- Doxorubicin (adriamycin)
- Vincristine
- For non-small cell lung cancer patients with good treatment response and with stable disease after initial chemotherapy, maintenance therapy may prolong survival
- To view chemotherapeutic regimens, click here
Complications
- Medical therapy complications for non-small cell lung cancer will depend on the chemotherapeutic agent.
- Common chemotherapy complications, include:
- Platinum-based chemotherapy
- The main dose-limiting side effect of cancer treatment with platinum compounds, include:
- Other chemotherapeutic agent complications, include:
References
- ↑ D'Antonio; Passaro A; Gori B (May 2014). "Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies". Therapeutic Advances in Medical Oncology. 6 (3): 101–114. doi:10.1177/1758834014521110. PMC 3987652. PMID 24790650.