Non small cell lung cancer medical therapy: Difference between revisions

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===Chemotherapy plus Radiation Therapy, Followed by Chemotherapy===
===Chemotherapy plus Radiation Therapy, Followed by Chemotherapy===
The list bellow show the options for concomitant [[chemotherapy]] plus [[radiation therapy]] followed by [[chemotherapy]] based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref>
The list below show the options for concomitant [[chemotherapy]] plus [[radiation therapy]] followed by [[chemotherapy]] based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.<ref name="NCCN">http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf</ref>


* [[Cisplatin]] 50 mg/m<sup>2</sup> on days 1, 8, 29 and 36 + [[etoposide]] 50 mg/m<sup>2</sup> through day 1 to 5 and then 29 to 33 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[cisplatin]] 50 mg/m<sup>2</sup> + [[etoposide]] 50 mg/m<sup>2</sup> to a total of 2 cycles.
* [[Cisplatin]] 50 mg/m<sup>2</sup> on days 1, 8, 29 and 36 + [[etoposide]] 50 mg/m<sup>2</sup> through day 1 to 5 and then 29 to 33 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[cisplatin]] 50 mg/m<sup>2</sup> + [[etoposide]] 50 mg/m<sup>2</sup> to a total of 2 cycles.

Revision as of 13:41, 16 January 2019

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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:

Chemotherapeutic Regimens

Shown below is a table depicting the different choices of regimens for the initial or adjuvant chemotherapy of patients with non-small cell lung cancer. The list of regimens has been adapted from the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[2][3]

Cisplatin Based Therapy

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 50 mg/m2 + pemetrexed 500 mg/m2 Cisplatin on day 1, pemetrexed on days 1 and every 21 days to a total of 4 cycles

Alternative Regimen

Paclitaxel 200 mg/m2 on day 1 + carboplatin area under the concentration (AUC) 6 on day 1 and then every 21 days.[3]

Chemotherapy with Radiation Therapy Regimens

Chemotherapy plus Radiation Therapy

The list bellow show the options for concomitant chemotherapy plus radiation therapy based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[3]

Chemotherapy Followed by Radiation Therapy

The list bellow show the options for chemotherapy followed by radiation therapy based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[3]

Chemotherapy plus Radiation Therapy, Followed by Chemotherapy

The list below show the options for concomitant chemotherapy plus radiation therapy followed by chemotherapy based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[3]

Complications

Medical therapy complications for non-small cell lung cancer will depend on the chemotherapeutic agent.

References

  1. 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.
  2. Alberti, W; Anderson, G; Bartolucci, A; Bell, D; et al. Chemotherapy in non-small cell lung cancer: A meta-analysis using updated data on individual patients from 52 randomised clinical trials. British Medical Journal, International edition311.7010 (Oct 7, 1995): 899
  3. 3.0 3.1 3.2 3.3 3.4 http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf


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