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{{Lung cancer}}
{{Lung cancer}}


{{CMG}}; '''Associate Editor(s)-In-Chief:''' Saarah T. Alkhairy, M.D.
{{CMG}}; {{AE}} {{STA}}
 
==Overview==
==Overview==
The medical therapy for lung cancer consists of surgery, radiation therapy, chemotherapy, and targeted therapy.  
[[Medical]] [[therapy]] for lung cancer consists of [[radiation therapy]], [[chemotherapy]], and targeted [[therapy]].


==Medical Therapy==
==Medical Therapy==
The medical therapy for lung cancer consists of surgery, radiation therapy, chemotherapy, and targeted therapy.


The table below summarizes the treatment for each stage of lung cancer for those who either refuse or unable to tolerate surgery.
* The table below summarizes the treatment for each [[Cancer staging|stage]] of lung cancer for those who either refuse or unable to tolerate [[surgery]].
{| {{table}}


| align="center" style="background:#f0f0f0;"|'''Stage'''
{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}}


| align="center" style="background:#f0f0f0;"|'''Treatment'''
| style="background:#f0f0f0;" align="center" |'''Stage'''
 
| style="background:#f0f0f0;" align="center" |'''Treatment'''


|-
|-


| '''I'''||Radiation therapy AND consider chemotherapy for high risk stage IB
!'''I'''
|
* [[Radiation therapy]] AND consider [[chemotherapy]] for high risk stage IB


|-
|-


| '''II (T2a, N0 OR T3, N0)'''||Consider chemotherapy for high risk stage II AND radiation therapy
!'''II (T2a, N0 OR T3, N0)'''
|
* Consider [[chemotherapy]] for high risk stage II AND [[radiation therapy]]


|-
|-


| '''II (T1a, N1 OR T1b, N1 OR T2a, N1 OR T2b, N1)'''||Chemoradiation
!'''II (T1a, N1 OR T1b, N1 OR T2a, N1 OR T2b, N1)'''
|
* [[Chemotherapy|Chemo]]-[[Radiation therapy|radiation]]


|-
|-


| '''III'''||Chemoradiation
!'''III'''
|
* [[Chemotherapy|Chemo]]-[[Radiation therapy|radiation]]


|}  
|}


The algorithm below demonstrates a treatment protocol for '''stage I''' patients that can tolerate surgery <ref>http://www.nccn.org/patients/guidelines/nscl/#56/z</ref>.  
* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage I who can tolerate [[surgery]]:''' <ref>http://www.nccn.org/patients/guidelines/nscl/#56/z</ref>.  


[[Image:Stage I.jpg|800px]]
[[Image:Stage I.jpg|800px]]
<br />


 
* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage II without invasion who can tolerate [[surgery]]: <ref>http://www.nccn.org/patients/guidelines/nscl/#58/z</ref>'''
The algorithm below demonstrates a treatment protocol for '''stage II without invasion''' patients that can tolerate surgery <ref>http://www.nccn.org/patients/guidelines/nscl/#58/z</ref>.


[[Image:Stage II without invasion.jpg|800px]]
[[Image:Stage II without invasion.jpg|800px]]


 
* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage II with invasion who can tolerate [[surgery]]:''' <ref>http://www.nccn.org/patients/guidelines/nscl/#61/z</ref>  
The algorithm below demonstrates a treatment protocol for '''stage II with invasion''' that can tolerate surgery <ref>http://www.nccn.org/patients/guidelines/nscl/#61/z</ref>.


[[Image:Stage II with invasion.jpg|800px]]
[[Image:Stage II with invasion.jpg|800px]]


* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage III without invasion who can tolerate [[surgery]]:''' <ref>http://www.nccn.org/patients/guidelines/nscl/#63/z</ref><ref>http://www.nccn.org/patients/guidelines/nscl/#64/z</ref>


The algorithm below demonstrates a treatment protocol for '''stage III without invasion''' that can tolerate surgery <ref>http://www.nccn.org/patients/guidelines/nscl/#63/z</ref><ref>http://www.nccn.org/patients/guidelines/nscl/#64/z</ref>.  
[[Image:Stage III without invasion.jpg|800px]]


[[Image:Stage III without invasion.jpg|800px]]
* '''The algorithm below demonstrates a treatment protocol for [[Patient|patients]] with stage III with invasion who can tolerate [[surgery]]:''' <ref>http://www.nccn.org/patients/guidelines/nscl/#66/z</ref><ref>http://www.nccn.org/patients/guidelines/nscl/#67/z</ref><br> [[Image:Stage III with invasion.jpg|800px]]


The algorithm below demonstrates a treatment protocol for '''stage III with invasion''' that can tolerate surgery <ref>http://www.nccn.org/patients/guidelines/nscl/#66/z</ref><ref>http://www.nccn.org/patients/guidelines/nscl/#67/z</ref>. <br>
* The treatment of '''stage 4''' lung cancers includes [[chemotherapy]] if the [[Eastern Cooperative Oncology Group|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. <ref>http://www.nccn.org/patients/guidelines/nscl/#72/z</ref>
[[Image:Stage III with invasion.jpg|800px]]


The treatment of '''stage 4''' lung cancers are treated with chemotherapy if the Eastern Cooperative Oncology Group (ECOG) Performance Scale is between 0 or 2. If the performance score is 3 or 4, the supportive care is recommended<ref>http://www.nccn.org/patients/guidelines/nscl/#72/z</ref>.
* The [[Eastern Cooperative Oncology Group|Eastern Cooperative Oncology Group (ECOG)]] Performance Scale is the following: <ref>http://www.nccn.org/patients/guidelines/nscl/#71/z</ref>


The Eastern Cooperative Oncology Group (ECOG) Performance Scale is the following<ref>http://www.nccn.org/patients/guidelines/nscl/#71/z</ref>:
**'''0:''' Fully active
*0 - fully active
**'''1:''' [[Self-care]] activities but unable to do hard physical work
*1 - self-care activities but unable to do hard physical work
**'''2:''' [[Self-care]] activities but unable to do any work
*2 - self-care activities but unable to do any work
**'''3:''' Unable to do any [[self-care]] activities or any work
*3 - unable to do any self-care activities or any work
**'''4:''' Fully [[Disability|disabled]]
*4 - fully disabled


===Surgery===
===Surgery===


To view the surgery of lung cancer, click [[Lung cancer surgery|'''here''']]
* To learn about the [[Surgery|surgical]] approach to lung cancer, click [[Lung cancer surgery|'''here''']].


===Radiation Therapy===
===Radiation Therapy===
Radiation therapy can be given with either one of two methods:
 
*External Beam Radiation Therapy (EBRT)  
* [[Radiation therapy]] can be administered via the following two methods:
 
==== 1. External Beam Radiation Therapy (EBRT) ====
 
:*This is more commonly used
:*This is more commonly used
:*The body receives radiation from an outside machine
:*The [[Human body|body]] receives [[radiation]] from an outside machine
:*The radiation is given in a series of sessions for about 8 weeks
:*The [[radiation]] is given in a series of sessions for about 8 weeks
*Internal Radiation Therapy (brachytherapy)
 
:*This therapy involves placing a radioactive object in or near the tumor
==== 2. Internal Radiation Therapy (Brachytherapy) ====
:*This can shrink a tumor that blocks the airway
 
*Possible side effects include the following:
:*This approach involves placing a [[radioactive]] object in or near the [[tumor]]
:*Dry, sore, painful skin
:*This can shrink an airway blocking [[tumor]]
:*Hair loss
 
:*Swelling of the lungs or esophagus
*Possible [[side effects]] include the following:
:*Fatigue
 
:*Loss of appetite
:*Dry, [[sore]], [[Pain|painful]] [[skin]]
:*[[Hair loss]]
:*[[Edema|Swelling]] of the [[Lung|lungs]] or [[esophagus]]
:*[[Fatigue]]
:*[[Loss of appetite]]


===Chemotherapy for Non Small Cell Lung Cancer===
===Chemotherapy for Non Small Cell Lung Cancer===


====Chemotherapy Regimens for Neoadjuvant and Adjuvant Therapy<ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>====
====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  
*[[Cisplatin]] 50 mg/m² days 1 and 8 AND [[vinorelbine]] 25 mg/m² days 1, 8, 15, 22, every 28 days for 4 cycles<ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>
*Cisplatin 100 mg/m2 day 1 AND vinorelbine 30 mg/m2 days 1, 8, 15, 22, every 28 days for 4 cycles
*[[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]] 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]] 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 wks after day 43, every 21 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 [[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 [[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 nonsquamous (without specific histologic subtype), every 21 days for 4 cycles
*[[Cisplatin]] 75 mg/m² day 1 AND [[pemetrexed]] 500 mg/m² day 1 for non-squamous (without specific [[Histology|histologic]] sub-type), every 21 days for 4 cycles


====Chemotherapy Regimens for Patients with Comorbidities or Patients Not Able to Tolerate Cisplatin<ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>====
====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
*[[Paclitaxel]] 200 mg/m² day 1, [[carboplatin]] AUC 6 day 1, every 21 days <ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>


====Concurrent Chemotherapy and Radiation Therapy Regimens<ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>====
====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
*[[Cisplatin]] 50 mg/m² on days 1, 8, 29, and 36 AND [[etoposide]] 50 mg/m² days 1 - 5, 29 - 33 WITH concurrent [[Chest|thoracic]] [[radiation therapy]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>
*Cisplatin 100 mg/m2 days 1 and 29 AND vinblastine 5 mg/m2/weekly x 5 WITH concurrent thoracic radiation therapy
*[[Cisplatin]] 100 mg/m² days 1 and 29 AND [[vinblastine]] 5 mg/m²/weekly x 5 WITH concurrent [[Chest|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
*[[Carboplatin]] AUC 5 on day 1 AND [[pemetrexed]] 500 mg/m² on day 1 every 21 days for 4 cycles WITH concurrent [[Chest|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
*[[Cisplatin]] 75 mg/m² on day 1 AND [[pemetrexed]] 500 mg/m² on day 1 every 21 days for 3 cycles WITH concurrent [[Chest|thoracic]] [[radiation therapy]]


====Sequential Chemotherapy and Radiation Therapy Regimens<ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>====
====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
*[[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]] <ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>
*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  
*[[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 [[Chest|thoracic]] [[radiation therapy]]


====Concurrent Chemotherapy and Radiation Therapy Followed by Chemotherapy<ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>====
====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  
*[[Paclitaxel]] 45 - 50 mg/m² weekly AND [[carboplatin]] AUC 2 WITH concurrent [[Chest|thoracic]] [[radiation therapy]] FOLLOWED by 2 cycles of [[paclitaxel]] 200 mg/m² and [[carboplatin]] AUC 6 <ref>http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf</ref>
*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  
*[[Cisplatin]] 50 mg/m² on days 1, 8, 29, and 36 AND [[etoposide]] 50 mg/m² days 1 - 5, 29 - 33 WITH concurrent [[Chest|thoracic]] [[radiation therapy]] FOLLOWED by [[cisplatin]] 50 mg/m² and [[etoposide]] 50 mg/m² x 2


===Chemotherapy for Non Small Cell Lung Cancer===
===Chemotherapy for Non Small Cell Lung Cancer===


====Chemotherapy as Primary or Adjuvant Therapy<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>====
====Chemotherapy as Primary or Adjuvant Therapy<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>====
'''LIMITED STAGE (MAXIMUM of 4-6 cycles):'''
'''Limited Stage (Maximum of 4 - 6 cycles):'''
*Cisplatin 60 mg/m2 day 1 AND etoposide 120 mg/m2 days 1, 2, 31  
*[[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  
*[[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  
*[[Carboplatin]] AUC 5 - 6 day 1 AND [[etoposide]] 100 mg/m² days 1, 2, 33


'''EXTENSIVE STAGE (MAXIMUM of 4-6 cycles):'''
'''Extensive Stage (Maximum of 4 - 6 cycles):'''
*[[Cisplatin]] 75 mg/m2 day 1 AND etoposide 100 mg/m2 days 1, 2, 3
*[[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]] 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
*[[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
*[[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]] 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
*[[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
*[[Carboplatin]] AUC 5 day 1 and [[irinotecan]] 50 mg/m² days 1, 8, 15


====Subsequent Chemotherapy (Relapse < 2-3 Months)<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>====
====Subsequent Chemotherapy (Relapse < 2 - 3 Months)====
*[[Paclitaxel]]
*[[Paclitaxel]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>
*[[Docetaxel]]
*[[Docetaxel]]
*[[Topotecan]]  
*[[Topotecan]]  
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*[[Gemcitabine]]
*[[Gemcitabine]]
*[[Ifosfamide]]
*[[Ifosfamide]]
*[[Bendamustine]]  
*[[Bendamustine]]


====Subsequent Chemotherapy (Relapse > 2-3 Months up to 6 Months)<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>====
====Subsequent Chemotherapy (Relapse > 2 - 3 Months up to 6 Months)====
*[[Topotecan]]
*[[Topotecan]]<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>
*[[Paclitaxel]]
*[[Paclitaxel]]
*[[Docetaxel]]
*[[Docetaxel]]
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*[[Gemcitabine]]
*[[Gemcitabine]]
*[[Vinorelbine]]
*[[Vinorelbine]]
*Oral [[etoposide]]
*[[Oral]] [[etoposide]]
*[[Temozolomide]]
*[[Temozolomide]]
*[[Cyclophosphamide]]/[[doxorubicin]]/[[vincristine]]  
*[[Cyclophosphamide]]/[[doxorubicin]]/[[vincristine]]  
*[[Bendamustine]]  
*[[Bendamustine]]  


====Subsequent Chemotherapy (Relapse > 6 Months)<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>====
====Subsequent Chemotherapy (Relapse > 6 Months)====
*Original regimen
*Original regimen<ref>http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf</ref>


===Targeted Therapy===
===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 drug, mechanism of action, and their common side effects<ref>http://www.nccn.org/patients/guidelines/nscl/#51/z</ref>:
* Targeted [[therapy]] treats selected lung cancers or is combined with [[chemotherapy]].  
* It is less likely to harm normal [[Cell (biology)|cells]] compared to [[chemotherapy]].


{| {{table}}
==== The table below summarizes the targeted [[therapy]] drugs' [[mechanism of action]] and common [[Adverse effect (medicine)|side effects]]: <ref>http://www.nccn.org/patients/guidelines/nscl/#51/z</ref> ====
{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}}


| align="center" style="background:#f0f0f0;"|'''Drug'''
| style="background:#f0f0f0;" align="center" |'''Drug'''


| align="center" style="background:#f0f0f0;"|'''Mechanism of Action'''
| style="background:#f0f0f0;" align="center" |'''Mechanism of Action'''


| align="center" style="background:#f0f0f0;"|'''Common Side Effects'''
| style="background:#f0f0f0;" align="center" |'''Common Side Effects'''


|-
|-


| Afatinib||Blocks the signals from EGFRs to prevent cell growth||Diarrhea, skin problems, mouth sores, and lack of appetite
! Afatinib
|
* Blocks the signals from [[EGFR]] to prevent [[cell growth]]
|
* [[Diarrhea]], [[skin]] problems, [[mouth sores]], and [[lack of appetite]]


|-
|-


| Bevacizumab||Stops the growth of new blood vessels||Diarrhea, high blood pressure, headache, fatigue, and mouth sores
! Bevacizumab
|
* Stops the [[growth]] of new [[Blood vessel|blood vessels]]
|
* [[Diarrhea]], [[Hypertension|high blood pressure]], [[headache]], [[fatigue]], and [[mouth sores]]


|-
|-


| Cetuximab||Attaches to EGFRs to prevent cell growth||Skin rash, fatigue, and weakness
! Cetuximab
|
* Attaches to [[EGFR]] to prevent [[cell growth]]
|
* [[Rash|Skin rash]], [[fatigue]], and [[weakness]]


|-
|-


| Crizotinib||Block the signals from ALKs to prevent cell growth||Lack of appetite, nausea, vomiting, diarrhea, visual defects, and flu-like symptoms
! Crizotinib
|
* Block the signals from [[anaplastic lymphoma kinase]] to prevent [[cell growth]]
|
* [[Lack of appetite]], [[nausea]], [[vomiting]], [[diarrhea]], [[Visual disturbance|visual defects]], and flu-like symptoms


|-
|-


| Erlotinib hydrocholoride||Blocks the signals from EGFRs to prevent cell growth||Skin rash on face, neck, or trench within the first 2 weeks of treatment, diarrhea, fatigue, lack of appetite, and nausea
! Erlotinib hydrocholoride
|
* Blocks the signals from [[EGFR]] to prevent [[cell growth]]
|
* [[Rash|Skin rash]] on [[face]], [[neck]], or [[trunk]] within the first 2 weeks of treatment, [[diarrhea]], [[fatigue]], [[lack of appetite]], and [[nausea]]


|}
|}
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Latest revision as of 20:18, 8 July 2019

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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]
    • 0: Fully active
    • 1: Self-care activities but unable to do hard physical work
    • 2: Self-care activities but unable to do any work
    • 3: Unable to do any self-care activities or any work
    • 4: Fully disabled

Surgery

  • To learn about the surgical approach to lung cancer, click here.

Radiation Therapy

1. External Beam Radiation Therapy (EBRT)

  • This is more commonly used
  • The body receives radiation from an outside machine
  • The radiation is given in a series of sessions for about 8 weeks

2. Internal Radiation Therapy (Brachytherapy)

  • This approach involves placing a radioactive object in or near the tumor
  • This can shrink an airway blocking tumor

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

Concurrent Chemotherapy and Radiation Therapy Regimens

Sequential Chemotherapy and Radiation Therapy Regimens

Concurrent Chemotherapy and Radiation Therapy Followed by Chemotherapy

Chemotherapy for Non Small Cell Lung Cancer

Chemotherapy as Primary or Adjuvant Therapy[15]

Limited Stage (Maximum of 4 - 6 cycles):

Extensive Stage (Maximum of 4 - 6 cycles):

Subsequent Chemotherapy (Relapse < 2 - 3 Months)

Subsequent Chemotherapy (Relapse > 2 - 3 Months up to 6 Months)

Subsequent Chemotherapy (Relapse > 6 Months)

  • Original regimen[18]

Targeted Therapy

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
Cetuximab
Crizotinib
Erlotinib hydrocholoride

References

  1. ↑ http://www.nccn.org/patients/guidelines/nscl/#56/z
  2. ↑ http://www.nccn.org/patients/guidelines/nscl/#58/z
  3. ↑ http://www.nccn.org/patients/guidelines/nscl/#61/z
  4. ↑ http://www.nccn.org/patients/guidelines/nscl/#63/z
  5. ↑ http://www.nccn.org/patients/guidelines/nscl/#64/z
  6. ↑ http://www.nccn.org/patients/guidelines/nscl/#66/z
  7. ↑ http://www.nccn.org/patients/guidelines/nscl/#67/z
  8. ↑ http://www.nccn.org/patients/guidelines/nscl/#72/z
  9. ↑ http://www.nccn.org/patients/guidelines/nscl/#71/z
  10. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  11. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  12. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  13. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  14. ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
  15. ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
  16. ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
  17. ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
  18. ↑ http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf
  19. ↑ http://www.nccn.org/patients/guidelines/nscl/#51/z

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