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]
Overview
Metastatic squamous cell carcinoma
| What is the performance status (PS) of the patient? | |||||||||||||||||||||||||||||||||||||||||||||||
| 0-1 | 2 | 3-4 | |||||||||||||||||||||||||||||||||||||||||||||
| Doublet chemotherapy OR Cetuximab/vinorelbine/cisplatin | Chemotherapy | Suportive care | |||||||||||||||||||||||||||||||||||||||||||||
| What was the tumor response to the treatment? | |||||||||||||||||||||||||||||||||||||||||||||||
| Progression | Positive response or stable tumor | ||||||||||||||||||||||||||||||||||||||||||||||
| Administer 4-6 cycles and assess progression of the disease | |||||||||||||||||||||||||||||||||||||||||||||||
| PS 0-2 | PS 3-4 | Tumor progression | Positive response or stable tumor | ||||||||||||||||||||||||||||||||||||||||||||
| Initiate docetaxel or erlotinib or gemcitabine | Provide suportive care | Initiate docetaxel or erlotinib or gemcitabine | Continuation mantainance (cetuximab or gemcitabine) OR Switch mantainance (erlotinib or decetaxel) OR Close observation | ||||||||||||||||||||||||||||||||||||||||||||
| Initiate docetaxel or pemetrexed or erlotinib or gemcitabine | |||||||||||||||||||||||||||||||||||||||||||||||
| If findings suggestive of progression of the disease are present, click here for the third line therapy | |||||||||||||||||||||||||||||||||||||||||||||||
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: patients with comorbidities or can't tolerate cisplatin
Paclitaxel 200 mg/m2 on day 1 + carboplatin area under the concentration (AUC) 6 on day 1 and then every 21 days.[1]
Chemotherapy plus radiotherapy regimens
Chemotherapy plus radiotherapy
The list bellow show the options for concomitant chemotherapy plus radiation therapy based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
- Cisplatin 50 mg/m2 on days 1, 8, 29 and 36 + etoposide 50 mg/m2 through days 1 to 5 and then 29 to 33 + thoracic radiotherapy
- Cisplatin 100 mg/m2 on days 1 and 29 + vinblastin 5 mg/m2 weekly for 5 weeks + thoracic radiotherapy
- Cisplatin 75 mg/m2 on the first day + pemetrexed 500 mg/m2 on day 1 and then every 21 days to a total of 3 cycles + thoracic radiotherapy
- Carboplatin (AUC) 5 on the first day + pemetrexed 500 mg/m2 on day 1 and then every 21 days to a total of 3 cycles + thoracic radiotherapy