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 chemo-radiation 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:
- 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 for platinum-based chemotherapy 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.