Squamous cell carcinoma of the lung medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2] Maria Fernanda Villarreal, M.D. [3]

Overview

The optimal treatment management of squamous cell carcinoma of the lung will depend on several characteristics. These include pre-treatment evaluation (performance status), location, and adequate staging. Common medical treatment options for the management of squamous cell carcinoma of the lung include chemotherapy (neoadjuvant/adjuvant) and radiation therapy.

Medical Therapy

  • The optimal treatment management of squamous cell carcinoma of the lung will depend on a series of characteristics, that include: pre-treatment evaluation, location, and adequate staging.
  • Common medical treatment options for the management of squamous cell carcinoma of the lung, include:[1]
  • Chemotherapy
  • To see chemotherapy for squamous cell carcinoma of the lung, click here
  • To see radiation therapy for squamous cell carcinoma of the lung, click here

Chemotherapy

  • Initial chemotherapy for patients with squamous cell carcinoma of the lung will depend on molecular testing, the presence of particular genetic mutations, and staging.
  • Chemotherapy for patients with squamous cell carcinoma of the lung, is divided into 2 main types: specific-inhibitor therapy (usually indicated with the presence of a genetic mutation) and platinum-based chemotherapy ( usually indicated with the absence of a genetic mutation)
  • Combination chemotherapy regimens using platinum-based chemotherapy and specific-inhibitors is the treatment of choice for the management of patients with squamous cell carcinoma of the lung
  • Erlotinib is the first-line treatment for patients with squamous cell carcinoma of the lung whose cancer has spread to other parts of the body and that has certain types of epidermal growth factor receptor (EGFR) mutations.
  • Chemotherapy treatments for squamous cell carcinoma of the lung, include:[2][3]
    • Paclitaxel
      • 175 mg/m2 over 3 hours every 3 weeks (as a single agent) for up to 5 cycles[4]
      • 80 mg/m2 over 1 hour weekly for 6 weeks of an 8-week treatment cycle (as a single agent) until disease progression or unacceptable toxicity.[5]
    • Cisplatin
      • 100 mg/m2 on day 1 every 4 weeks (in combination with etoposide) for 3 to 4 cycles;[6]
      • 100 mg/m2 on day 1 every 4 weeks (in combination with vinorelbine)[7][8]
      • 100 mg/m2 on day 1 every 4 weeks (in combination with gemcitabine)[9]
      • 80 mg/m2 on day 1 every 3 weeks (in combination with gemcitabine)[10]
      • 75 mg/m2 on day 1 every 3 weeks (in combination with pemetrexed) for up to 6 cycles or until disease progression or unacceptable toxicity[11]
    • Erlotinib
      • Oral: 150 mg once daily until disease progression or unacceptable toxicity[12][13][14]
    • Afatinib
      • Oral: 40 mg once daily until disease progression or unacceptable toxicity
      • Missed doses:Do not take a missed dose within 12 hours of next dose
    • Gefitinib
      • Oral: 250 mg once daily until disease progression or unacceptable toxicity
      • Missed doses:Do not take a missed dose if it is within 12 hours of the next scheduled dose
    • Crizotinib
      • Oral:250 mg twice daily, continue treatment until disease progression or unacceptable toxicity
      • Missed doses:If a dose is missed, take as soon as remembered unless it is <6 hours prior to the next scheduled dose (skip the dose if <6 hours before the next dose); do not take 2 doses at the same time to make up for a missed dose. If vomiting occurs after dose, administer the next dose at the regularly scheduled time
    • Vinorelbine[8]
    • Gemcitabine[9]
    • Carboplatin
      • IV:Target AUC 6 every 3 to 4 weeks (in combination with paclitaxel)[15][16][17]
      • Target AUC 6 every 3 weeks (in combination with bevacizumab and paclitaxel)[18]
      • Target AUC 5 every 3 weeks (in combination with pemetrexed)[19]
      • Target AUC 6 every 3 weeks (in combination with pemetrexed and bevacizumab) for up to 4 cycles followed by maintenance therapy[20] or in combination with radiation therapy and paclitaxel[16]
      • Target AUC 6 every 3 weeks for 2 cycles
      • Target AUC 6 every 3 weeks for 2 cycles
      • Target AUC 2 weekly for 7 weeks
      • Target AUC 2 every week for 7 weeks; then target AUC 6 every 3 weeks for 2 cycles
    • Etoposide
      • IV: 35 mg/m2/day for 4 days, up to 50 mg/m2/day for 5 days every 3 to 4 weeks
      • Oral: Due to poor bioavailability, oral doses should be twice the IV dose (and rounded to the nearest 50 mg)
    • Docetaxel
      • IV: 75 mg/m2 every 3 weeks (as a single agent or in combination with cisplatin)
    • Pemetrexed
      • IV:Initial treatment of locally advanced or metastatic NSCLC: 500 mg/m2 on day 1 of each 21-day cycle (in combination with cisplatin) for up to 6 cycles or until disease progression or unacceptable toxicity
      • Maintenance treatment of locally advanced or metastatic NSCLC (after 4 cycles of initial platinum-based therapy): 500 mg/m2 on day 1 of each 21-day cycle (as a single-agent); continue until disease progression or unacceptable toxicity
      • Second-line treatment of recurrent/metastatic disease (after prior chemotherapy): 500 mg/m2 on day 1 of each 21-day cycle (as a single-agent); continue until disease progression or unacceptable toxicity
  • Platinum-based chemotherapy (cisplatin, carboplatin,
  • , irinotecan) are the mainstay of squamous cell carcinoma of the lung
  • Platinum-based chemotherapy consists of four to six cycles
  • Cisplatin is the preferred platinum based agent of choice when the therapy is used with curative intent
  • To see more information about mangnagment approach for non-small cell lung cancer click here
  • To see more information about the chemotherapeutic regimens in non-small cell lung cancer click here

Complications of Chemotherapy

  • Medical therapy complications for squamous cell carcinoma of the lung will depend on the chemotherapeutic agent.
  • Common chemotherapy complications, include:[2]
  • Platinum-based chemotherapy, the main dose-limiting side effect of cancer treatment with platinum compounds, include:
  • Other chemotherapeutic agent complications, include:
  • Side effects symptoms of chemotherapeutic agents, include:

Radiation Therapy

  • Radiation therapy for squamous cell carcinoma of the lung, includes:[21]
  • Indications for radiation therapy in squamous cell carcinoma of the lung, include:
  • Sufficient pulmonary reserve
  • Stage I
  • Stage II without fitness for surgery
  • Stage IIIA or IIIB squamous cell carcinoma of the lung and are not fit for chemoradiation
  • Common types of external beam radiation therapy for the treatment of squamous cell carcinoma of the lung, include:

References

  1. ↑ Melville A, Eastwood A (1998). "Management of lung cancer". Qual Health Care. 7 (3): 170–7. PMC 2483609. PMID 10185145.
  2. ↑ 2.0 2.1 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. ↑ Moran T, Sequist L. Timing of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Therapy in Patients With Lung Cancer With EGFR Mutations. J Clin Oncol 2012; 30:3330
  4. ↑ Smit EF, Fokkema E, Biesma B, Groen HJ, Snoek W, Postmus PE (1998). "A phase II study of paclitaxel in heavily pretreated patients with small-cell lung cancer". Br. J. Cancer. 77 (2): 347–51. PMC 2151229. PMID 9461009.
  5. ↑ Yamamoto N, Tsurutani J, Yoshimura N, Asai G, Moriyama A, Nakagawa K, Kudoh S, Takada M, Minato Y, Fukuoka M (2006). "Phase II study of weekly paclitaxel for relapsed and refractory small cell lung cancer". Anticancer Res. 26 (1B): 777–81. PMID 16739353.
  6. ↑ Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J (January 2004). "Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer". N. Engl. J. Med. 350 (4): 351–60. doi:10.1056/NEJMoa031644. PMID 14736927.
  7. ↑ Kelly K, Crowley J, Bunn PA, Presant CA, Grevstad PK, Moinpour CM, Ramsey SD, Wozniak AJ, Weiss GR, Moore DF, Israel VK, Livingston RB, Gandara DR (July 2001). "Randomized phase III trial of paclitaxel plus carboplatin versus vinorelbine plus cisplatin in the treatment of patients with advanced non--small-cell lung cancer: a Southwest Oncology Group trial". J. Clin. Oncol. 19 (13): 3210–8. doi:10.1200/JCO.2001.19.13.3210. PMID 11432888.
  8. ↑ 8.0 8.1 Wozniak AJ, Crowley JJ, Balcerzak SP, Weiss GR, Spiridonidis CH, Baker LH, Albain KS, Kelly K, Taylor SA, Gandara DR, Livingston RB (July 1998). "Randomized trial comparing cisplatin with cisplatin plus vinorelbine in the treatment of advanced non-small-cell lung cancer: a Southwest Oncology Group study". J. Clin. Oncol. 16 (7): 2459–65. doi:10.1200/JCO.1998.16.7.2459. PMID 9667264.
  9. ↑ 9.0 9.1 Comella P, Frasci G, Panza N, Manzione L, De Cataldis G, Cioffi R, Maiorino L, Micillo E, Lorusso V, Di Rienzo G, Filippelli G, Lamberti A, Natale M, Bilancia D, Nicolella G, Di Nota A, Comella G (April 2000). "Randomized trial comparing cisplatin, gemcitabine, and vinorelbine with either cisplatin and gemcitabine or cisplatin and vinorelbine in advanced non-small-cell lung cancer: interim analysis of a phase III trial of the Southern Italy Cooperative Oncology Group". J. Clin. Oncol. 18 (7): 1451–7. doi:10.1200/JCO.2000.18.7.1451. PMID 10735892.
  10. ↑ Ohe Y, Ohashi Y, Kubota K, Tamura T, Nakagawa K, Negoro S, Nishiwaki Y, Saijo N, Ariyoshi Y, Fukuoka M (February 2007). "Randomized phase III study of cisplatin plus irinotecan versus carboplatin plus paclitaxel, cisplatin plus gemcitabine, and cisplatin plus vinorelbine for advanced non-small-cell lung cancer: Four-Arm Cooperative Study in Japan". Ann. Oncol. 18 (2): 317–23. doi:10.1093/annonc/mdl377. PMID 17079694.
  11. ↑ Scagliotti GV, Parikh P, von Pawel J, Biesma B, Vansteenkiste J, Manegold C, Serwatowski P, Gatzemeier U, Digumarti R, Zukin M, Lee JS, Mellemgaard A, Park K, Patil S, Rolski J, Goksel T, de Marinis F, Simms L, Sugarman KP, Gandara D (July 2008). "Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer". J. Clin. Oncol. 26 (21): 3543–51. doi:10.1200/JCO.2007.15.0375. PMID 18506025.
  12. ↑ Cappuzzo F, Ciuleanu T, Stelmakh L, Cicenas S, Szczésna A, Juhász E, Esteban E, Molinier O, Brugger W, Melezínek I, Klingelschmitt G, Klughammer B, Giaccone G (June 2010). "Erlotinib as maintenance treatment in advanced non-small-cell lung cancer: a multicentre, randomised, placebo-controlled phase 3 study". Lancet Oncol. 11 (6): 521–9. doi:10.1016/S1470-2045(10)70112-1. PMID 20493771.
  13. ↑ Rosell R, Carcereny E, Gervais R, Vergnenegre A, Massuti B, Felip E, Palmero R, Garcia-Gomez R, Pallares C, Sanchez JM, Porta R, Cobo M, Garrido P, Longo F, Moran T, Insa A, De Marinis F, Corre R, Bover I, Illiano A, Dansin E, de Castro J, Milella M, Reguart N, Altavilla G, Jimenez U, Provencio M, Moreno MA, Terrasa J, Muñoz-Langa J, Valdivia J, Isla D, Domine M, Molinier O, Mazieres J, Baize N, Garcia-Campelo R, Robinet G, Rodriguez-Abreu D, Lopez-Vivanco G, Gebbia V, Ferrera-Delgado L, Bombaron P, Bernabe R, Bearz A, Artal A, Cortesi E, Rolfo C, Sanchez-Ronco M, Drozdowskyj A, Queralt C, de Aguirre I, Ramirez JL, Sanchez JJ, Molina MA, Taron M, Paz-Ares L (March 2012). "Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial". Lancet Oncol. 13 (3): 239–46. doi:10.1016/S1470-2045(11)70393-X. PMID 22285168.
  14. ↑ Shepherd FA, Rodrigues Pereira J, Ciuleanu T, Tan EH, Hirsh V, Thongprasert S, Campos D, Maoleekoonpiroj S, Smylie M, Martins R, van Kooten M, Dediu M, Findlay B, Tu D, Johnston D, Bezjak A, Clark G, Santabárbara P, Seymour L (July 2005). "Erlotinib in previously treated non-small-cell lung cancer". N. Engl. J. Med. 353 (2): 123–32. doi:10.1056/NEJMoa050753. PMID 16014882.
  15. ↑ Rao RD, Holtan SG, Ingle JN, Croghan GA, Kottschade LA, Creagan ET, Kaur JS, Pitot HC, Markovic SN (January 2006). "Combination of paclitaxel and carboplatin as second-line therapy for patients with metastatic melanoma". Cancer. 106 (2): 375–82. doi:10.1002/cncr.21611. PMID 16342250.
  16. ↑ 16.0 16.1 Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, Zhu J, Johnson DH (January 2002). "Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer". N. Engl. J. Med. 346 (2): 92–8. doi:10.1056/NEJMoa011954. PMID 11784875.
  17. ↑ Strauss GM, Herndon JE, Maddaus MA, Johnstone DW, Johnson EA, Harpole DH, Gillenwater HH, Watson DM, Sugarbaker DJ, Schilsky RL, Vokes EE, Green MR (November 2008). "Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups". J. Clin. Oncol. 26 (31): 5043–51. doi:10.1200/JCO.2008.16.4855. PMC 2652093. PMID 18809614.
  18. ↑ Sandler A, Gray R, Perry MC, Brahmer J, Schiller JH, Dowlati A, Lilenbaum R, Johnson DH (December 2006). "Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer". N. Engl. J. Med. 355 (24): 2542–50. doi:10.1056/NEJMoa061884. PMID 17167137.
  19. ↑ Grønberg BH, Bremnes RM, Fløtten O, Amundsen T, Brunsvig PF, Hjelde HH, Kaasa S, von Plessen C, Stornes F, Tollåli T, Wammer F, Aasebø U, Sundstrøm S (July 2009). "Phase III study by the Norwegian lung cancer study group: pemetrexed plus carboplatin compared with gemcitabine plus carboplatin as first-line chemotherapy in advanced non-small-cell lung cancer". J. Clin. Oncol. 27 (19): 3217–24. doi:10.1200/JCO.2008.20.9114. PMID 19433683.
  20. ↑ Patel JD, Socinski MA, Garon EB, Reynolds CH, Spigel DR, Olsen MR, Hermann RC, Jotte RM, Beck T, Richards DA, Guba SC, Liu J, Frimodt-Moller B, John WJ, Obasaju CK, Pennella EJ, Bonomi P, Govindan R (December 2013). "PointBreak: a randomized phase III study of pemetrexed plus carboplatin and bevacizumab followed by maintenance pemetrexed and bevacizumab versus paclitaxel plus carboplatin and bevacizumab followed by maintenance bevacizumab in patients with stage IIIB or IV nonsquamous non-small-cell lung cancer". J. Clin. Oncol. 31 (34): 4349–57. doi:10.1200/JCO.2012.47.9626. PMC 4881367. PMID 24145346.
  21. ↑ Pattern of use of radiotherapy for lung cancer: a descriptive study. BioMed Central. http://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-14-697#CR6 Accessed on March 1, 2016


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