Lung cancer medical therapy
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Risk calculators and risk factors for Lung cancer medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saarah T. Alkhairy M.D
Overview
Medical therapy for lung cancer consists of radiation therapy, chemotherapy, and targeted therapy.
Medical Therapy
- The table below summarizes the treatment for each stage of lung cancer for those who either refuse or unable to tolerate surgery.
| Stage | Treatment |
| I |
|
|---|---|
| II (T2a, N0 OR T3, N0) |
|
| II (T1a, N1 OR T1b, N1 OR T2a, N1 OR T2b, N1) | |
| III |
- The algorithm below demonstrates a treatment protocol for patients with stage I who can tolerate surgery: [1].
- The algorithm below demonstrates a treatment protocol for patients with stage II without invasion who can tolerate surgery: [2]
- The algorithm below demonstrates a treatment protocol for patients with stage II with invasion who can tolerate surgery: [3]
- The algorithm below demonstrates a treatment protocol for patients with stage III without invasion who can tolerate surgery: [4][5]
- The algorithm below demonstrates a treatment protocol for patients with stage III with invasion who can tolerate surgery: [6][7]
- The treatment of stage 4 lung cancers includes chemotherapy if the Eastern Cooperative Oncology Group (ECOG) Performance Scale is between 0 and 2. If the Performance Score is 3 or 4, then supportive care is recommended. [8]
- The Eastern Cooperative Oncology Group (ECOG) Performance Scale is the following: [9]
Surgery
Radiation Therapy
- Radiation therapy can be administered via the following two methods:
1. External Beam Radiation Therapy (EBRT)
2. Internal Radiation Therapy (Brachytherapy)
- This approach involves placing a radioactive object in or near the tumor
- This can shrink an airway blocking tumor
- Possible side effects include the following:
Chemotherapy for Non Small Cell Lung Cancer
Chemotherapy Regimens as Neo-adjuvant and Adjuvant Therapy
- Cisplatin 50 mg/m² days 1 and 8 AND vinorelbine 25 mg/m² days 1, 8, 15, 22, every 28 days for 4 cycles[10]
- Cisplatin 100 mg/m² day 1 AND vinorelbine 30 mg/m² days 1, 8, 15, 22, every 28 days for 4 cycles
- Cisplatin 75 - 80 mg/m² day 1 AND vinorelbine 25 - 30 mg/m² days 1 + 8, every 21 days for 4 cycles
- Cisplatin 100 mg/m² day 1 AND etoposide 100 mg/m² days 1 - 3, every 28 days for 4 cycles
- Cisplatin 80 mg/m² days 1, 22, 43, 64 AND vinblastine 4 mg/m² days 1, 8, 15, 22, 29 then every 2 weeks after day 43, every 21 days for 4 cycles
- Cisplatin 75 mg/m² day 1 AND gemcitabine 1250 mg/m² days 1, 8, every 21 days for 4 cycles
- Cisplatin 75 mg/m² day 1 AND docetaxel 75 mg/m² day 1, every 21 days for 4 cycles
- Cisplatin 75 mg/m² day 1 AND pemetrexed 500 mg/m² day 1 for non-squamous (without specific histologic sub-type), every 21 days for 4 cycles
Chemotherapy Regimens for Patients with Comorbidities or Patients Not Able to Tolerate Cisplatin
- Paclitaxel 200 mg/m² day 1, carboplatin AUC 6 day 1, every 21 days [11]
Concurrent Chemotherapy and Radiation Therapy Regimens
- Cisplatin 50 mg/m² on days 1, 8, 29, and 36 AND etoposide 50 mg/m² days 1 - 5, 29 - 33 WITH concurrent thoracic radiation therapy[12]
- Cisplatin 100 mg/m² days 1 and 29 AND vinblastine 5 mg/m²/weekly x 5 WITH concurrent thoracic radiation therapy
- Carboplatin AUC 5 on day 1 AND pemetrexed 500 mg/m² on day 1 every 21 days for 4 cycles WITH concurrent thoracic radiation therapy
- Cisplatin 75 mg/m² on day 1 AND pemetrexed 500 mg/m² on day 1 every 21 days for 3 cycles WITH concurrent thoracic radiation therapy
Sequential Chemotherapy and Radiation Therapy Regimens
- Cisplatin 100 mg/m² on days 1 and 29 AND vinblastine 5 mg/m²/weekly on days 1, 8, 15, 22, and 29 FOLLOWED by radiation therapy [13]
- Paclitaxel 200 mg/m² over 3 hours on day 1 AND carboplatin AUC 6 over 60 minutes on day 1 every 3 weeks for 2 cycles FOLLOWED by thoracic radiation therapy
Concurrent Chemotherapy and Radiation Therapy Followed by Chemotherapy
- Paclitaxel 45 - 50 mg/m² weekly AND carboplatin AUC 2 WITH concurrent thoracic radiation therapy FOLLOWED by 2 cycles of paclitaxel 200 mg/m² and carboplatin AUC 6 [14]
- Cisplatin 50 mg/m² on days 1, 8, 29, and 36 AND etoposide 50 mg/m² days 1 - 5, 29 - 33 WITH concurrent thoracic radiation therapy FOLLOWED by cisplatin 50 mg/m² and etoposide 50 mg/m² x 2
Chemotherapy for Non Small Cell Lung Cancer
Chemotherapy as Primary or Adjuvant Therapy[15]
Limited Stage (Maximum of 4 - 6 cycles):
- Cisplatin 60 mg/m² day 1 AND etoposide 120 mg/m² days 1, 2, 31
- Cisplatin 80 mg/m² day 1 AND etoposide 100 mg/m² days 1, 2, 32
- Carboplatin AUC 5 - 6 day 1 AND etoposide 100 mg/m² days 1, 2, 33
Extensive Stage (Maximum of 4 - 6 cycles):
- Cisplatin 75 mg/m² day 1 AND etoposide 100 mg/m² days 1, 2, 3
- Cisplatin 80 mg/m² day 1 AND etoposide 80 mg/m² days 1, 2, 3
- Cisplatin 25 mg/m² days 1, 2, 3 AND etoposide 100 mg/m² days 1, 2, 3
- Carboplatin AUC 5 - 6 day 1 AND etoposide 100 mg/m² days 1, 2, 3
- Cisplatin 60 mg/m² day 1 AND irinotecan 60 mg/m² days 1, 8, 15
- Cisplatin 30 mg/m² AND irinotecan 65 mg/m² days 1, 89
- Carboplatin AUC 5 day 1 and irinotecan 50 mg/m² days 1, 8, 15
Subsequent Chemotherapy (Relapse < 2 - 3 Months)
Subsequent Chemotherapy (Relapse > 2 - 3 Months up to 6 Months)
- Topotecan[17]
- Paclitaxel
- Docetaxel
- Irinotecan
- Gemcitabine
- Vinorelbine
- Oral etoposide
- Temozolomide
- Cyclophosphamide/doxorubicin/vincristine
- Bendamustine
Subsequent Chemotherapy (Relapse > 6 Months)
- Original regimen[18]
Targeted Therapy
- Targeted therapy treats selected lung cancers or is combined with chemotherapy.
- It is less likely to harm normal cells compared to chemotherapy.
The table below summarizes the targeted therapy drugs' mechanism of action and common side effects: [19]
| Drug | Mechanism of Action | Common Side Effects |
| Afatinib |
|
|
|---|---|---|
| Bevacizumab |
|
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| Cetuximab |
|
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| Crizotinib |
|
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| Erlotinib hydrocholoride |
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References
- ↑ http://www.nccn.org/patients/guidelines/nscl/#56/z
- ↑ http://www.nccn.org/patients/guidelines/nscl/#58/z
- ↑ http://www.nccn.org/patients/guidelines/nscl/#61/z
- ↑ http://www.nccn.org/patients/guidelines/nscl/#63/z
- ↑ http://www.nccn.org/patients/guidelines/nscl/#64/z
- ↑ http://www.nccn.org/patients/guidelines/nscl/#66/z
- ↑ http://www.nccn.org/patients/guidelines/nscl/#67/z
- ↑ http://www.nccn.org/patients/guidelines/nscl/#72/z
- ↑ http://www.nccn.org/patients/guidelines/nscl/#71/z
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
- ↑ http://www.nccn.org/patients/guidelines/nscl/#51/z