Non small cell lung cancer chemotherapy: Difference between revisions

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* [[Paclitaxel]] 45 to 50 mg/m<sup>2</sup> once a week + carboplatin AUC 2 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[Paclitaxel]] 200 mg/m<sup>2</sup> + carboplatin AUC 6 to a total of 2 cycles.
* [[Paclitaxel]] 45 to 50 mg/m<sup>2</sup> once a week + carboplatin AUC 2 + [[Non small cell carcinoma of the lung radiation therapy|thoracic radiation therapy]], then followed by [[Paclitaxel]] 200 mg/m<sup>2</sup> + carboplatin AUC 6 to a total of 2 cycles.


==Treatment Management by Stage==
*The table below summarizes the different standard treatment options according to the TNM criteria for non-small cell lung cancer
{|style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align=center
!style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" colspan="3"|{{fontcolor|#FFF|'''Standard Treatment Options'''<br><SMALL>Adapted from Non-Small Cell Lung Cancer Treatment (PDQ® 2016) <ref name="PDQ"> PDQ Adult Treatment Editorial Board. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032637/ Accessed on February 22, 2016 </ref></SMALL>}}
|+
|-
! style="background: #4479BA; width: 50px;" | {{fontcolor|#FFF|'''Stage (TNM criteria)'''}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|'''Standard Treatment Options'''}}
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Occult'''
|style="padding: 5px 5px; background: #F5F5F5;"| 
* Surgery
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stage 0'''
|style="padding: 5px 5px; background: #F5F5F5;"| 
*Surgery
*Endobronchial therapies
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stages IA and IB'''
|style="padding: 5px 5px; background: #F5F5F5;"| 
*Surgery
*Radiation therapy
*IB,  if the tumor is >4cm,  surgery and chemotherapy
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|'''Stages IIA and IIB'''
|style="padding: 5px 5px; background: #F5F5F5;"| 
*Surgery
*Neoadjuvant chemotherapy
*Adjuvant chemotherapy
*Radiation therapy
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stage IIIA'''
|style="padding: 5px 5px; background: #F5F5F5;"| 
'''Resected or resectable disease'''
*Surgery
*Neoadjuvant therapy
*Adjuvant therapy
'''Unresectable disease'''
*Radiation therapy
*Chemoradiation therapy
'''Superior sulcus tumors '''
*Radiation therapy alone
*Radiation therapy and surgery
*Concurrent chemotherapy with radiation therapy and surgery
*Surgery alone (for selected patients)
'''Tumors that invade the chest wall'''
*Surgery
*Surgery and radiation therapy
*Radiation therapy alone
*Chemotherapy combined with radiation therapy and/or surgery
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stage IIIB'''
|style="padding: 5px 5px; background: #F5F5F5;"| 
*Sequential or concurrent chemotherapy and radiation therapy
*Chemotherapy followed by surgery (for selected patients)
*Radiation therapy alone
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Stage IV'''
|style="padding: 5px 5px; background: #F5F5F5;"| 
*Cytotoxic combination chemotherapy (first line)
*Combination chemotherapy with bevacizumab or cetuximab
*EGFR tyrosine kinase inhibitors (first line)
*EML4-ALK inhibitors in patients with EML-ALK translocations
*Immune checkpoint inhibition with nivolumab for selected patients with squamous or nonsquamous metastatic
Maintenance therapy following first-line chemotherapy
* Endobronchial laser therapy and/or brachytherapy (for obstructing lesions)
* External-beam radiation therapy (primarily for palliation of local symptomatic tumor growth)
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| '''Recurrent'''
|style="padding: 5px 5px; background: #F5F5F5;"| 
*Radiation therapy (for palliation)
*Chemotherapy or kinase inhibitors alone EGFR inhibitors in patients with/without EGFR mutations
*EML4-ALK inhibitors in patients with EML-ALK translocations
*Surgical resection of isolated cerebral metastasis (for highly selected patients)
*Laser therapy or interstitial radiation therapy (for endobronchial lesions)
*Stereotactic radiation surgery (for highly selected patients)
|}


==References==
==References==

Revision as of 16:50, 2 March 2016

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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]

Overview

Chemotherapeutic regimens based on platinum agents have demonstrated longer survival rates, better symptom control and higher quality of life when compared with best supportive care.

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.[1]

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.[1]

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.[1]

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.[1]


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.[1]


References