Lung cancer medical therapy

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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

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