Lung cancer medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, Cafer Zorkun, M.D., Ph.D. [2]

Overview

The use chemotherapy and the specific regimen used depends on the tumor type.

Medical Therapy

Chemotherapy

Small cell lung carcinoma, even if relatively early stage, is treated primarily with chemotherapy and radiation[1] as surgery has no demonstrable influence on survival. In small cell lung carcinoma, cisplatin and etoposide are most commonly used.[2] Combinations with carboplatin, gemcitabine, paclitaxel, vinorelbine, topotecan and irinotecan are also used.[3][4] In extensive-stage small-cell lung cancercelecoxib may have a role.[5]

Primary chemotherapy is also given in metastatic non-small cell lung carcinoma. Advanced non-small cell lung carcinoma is often treated with cisplatin or carboplatin, in combination with gemcitabine, paclitaxel, docetaxel, etoposide, orvinorelbine.[6] Bevacizumab improves results in non-squamous cancers treated with paclitaxel and carboplatin in patients less than 70 years old who have reasonable general performance status. [7] Bronchoalveolar carcinoma is a subtype of non-small cell lung carcinoma that may respond to gefitinib[8] and erlotinib.[9]

Testing for the molecular genetic subtype of non-small cell lung cancer may be of assistance in selecting the most appropriate initial therapy[10] For example, mutation of the epidermal growth factor receptor gene[11] may predict whether initial treatment with a specific inhibitor or with chemotherapy is more advantageous.[12]

Maintenance therapy in advanced non-small cell lung cancer refers to continuing treatment after an initial response to therapy.[13] Switch maintenance changes to different medications than the initial therapy and can use pemetrexed,[14] erlotinib,[15] and docetaxel,[16] although pemetrexed is only used in non-squamous NSCLC.[17]

Adjuvant chemotherapy for non-small cell lung carcinoma

Adjuvant chemotherapy refers to the use of chemotherapy after surgery to improve the outcome. During surgery, samples are taken from the lymph nodes. If these samples contain cancer, then the patient has stage II or III disease. In this situation, adjuvant chemotherapy may improve survival by up to 15%.[18][19] Standard practice is to offer platinum-based chemotherapy (including either cisplatin or carboplatin).[20]

Adjuvant chemotherapy for patients with stage IB cancer is controversial as clinical trials have not clearly demonstrated a survival benefit.[21][22] Trials of preoperative chemotherapy (neoadjuvant chemotherapy) in resectable non-small cell lung carcinoma have been inconclusive.[23]

References

  1. ↑ Hann CL, Rudin CM (2008 Nov 30). "Management of small-cell lung cancer: incremental changes but hope for the future". Oncology (Williston Park). 22 (13): 1486–92. Check date values in: |date= (help)
  2. ↑ Murray, N (Mar 2006). "A review of first-line treatment for small-cell lung cancer". Journal of Thoracic Oncology. 1 (3): 270–278. PMID 17409868. Unknown parameter |coauthors= ignored (help)
  3. ↑ Azim, HA (Mar 2007). "Treatment options for relapsed small-cell lung cancer". Anticancer drugs. 18 (3): 255–261. PMID 17264756. Unknown parameter |coauthors= ignored (help)
  4. ↑ MacCallum, C (Jul 2006). "Second-line treatment of small-cell lung cancer". Current Oncology Reports. 8 (4): 258–264. PMID 17254525. Unknown parameter |coauthors= ignored (help)
  5. ↑ Arúajo AM, Mendez JC, Coelho AL, Sousa B, Barata F, Figueiredo A; et al. (2009). "Phase II study of celecoxib with cisplatin plus etoposide in extensive-stage small cell lung cancer". Cancer Invest. 27 (4): 391–6. doi:10.1080/07357900802232756. PMID 19266367.
  6. ↑ Clegg, A (Jan 2002). "Clinical and cost effectiveness of paclitaxel, docetaxel, gemcitabine, and vinorelbine in non-small cell lung cancer: a systematic review". Thorax. BMJ Publishing Group Ltd. 57 (1): 20–28. PMID 11809985. Unknown parameter |coauthors= ignored (help)
  7. ↑ Sandler A, Gray R, Perry MC; et al. (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.
  8. ↑ West HL, Franklin WA, McCoy J; et al. (2006). "Gefitinib therapy in advanced brochoalveolar carcinoma. Southwest Oncology Group study S0126". J Clin Oncol. 24 (12): 1807–13. doi:10.1200/JCO.2005.04.9890. PMID 16622257.
  9. ↑ Miller VA, Riely GJ, Zakowski MF; et al. (2008). "Molecular characteristics of bronchoalveolar carcinoma and adenocarcinoma, brochoalveolar carcinoma subtype, predict response to erlotinib". J Clin Oncol. 26 (9): 1472–8. doi:10.1200/JCO.2007.13.0062. PMID 18349398.
  10. ↑ Aggarwal C; et al. (2010). "Biomarkers with predictive and prognostic function in non-small cell lung cancer: ready for prime time?". J Natl Compr Canc Netw. 8: 822–32.
  11. ↑ Rosell, R; Moran, T; Queralt, C; Porta, R; Cardenal, F; Camps, C; Majem, M; Lopez-Vivanco, G; Isla, D (2009). "Screening for epidermal growth factor receptor mutations in lung cancer". N Engl J Med. 361 (10): 958–67. doi:10.1056/NEJMoa0904554. PMID 19692684.
  12. ↑ Mok TS; et al. (2009). "Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma". N Engl J Med. 361 (10): 947–57. doi:10.1056/NEJMoa0810699. PMID 19692680.
  13. ↑ Eaton KD, Martins RG (2010 Jul). "Maintenance chemotherapy in non-small cell lung cancer". J Natl Compr Canc Netw. 8 (7): 815–21. PMID 20679540. Check date values in: |date= (help)
  14. ↑ Ciuleanu T, Brodowicz T, Zielinski C; et al. (2009). "Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study". Lancet. 374: 1432–40. doi:10.1016/S0140-6736(09)61497-5.
  15. ↑ Cappuzzo F, Ciuleanu T, Stelmakh L; et al. (2010). "Erlotinib as maintenance treatment in advanced non-small-cell lung cancer: a multicentre, randomised, placebo-controlled phase 3 study". Lancet Oncol. 11: 521–9. doi:10.1016/S1470-2045(10)70112-1.
  16. ↑ Fidias PM, Dakhil SR, Lyss AP; et al. (2009). "Phase III study of immediate compared with delayed docetaxel after front-line therapy with gemcitabine plus carboplatin in advanced non-small-cell lung cancer". J Clin Oncol. 27 (4): 591–8. doi:10.1200/JCO.2008.17.1405. PMID 19075278.
  17. ↑ Rossi A, Ricciardi S, Maione P, de Marinis F, Gridelli C (2009). "Pemetrexed in the treatment of advanced non-squamous lung cancer". Lung Cancer. 66 (2): 141–9. doi:10.1016/j.lungcan.2009.06.006. PMID 19577816.
  18. ↑ Winton, T (Jun 2005). "Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer". New England Journal of Medicine. Massachusetts Medical Society. 352 (25): 2589–2597. PMID 15972865. Unknown parameter |coauthors= ignored (help)
  19. ↑ Douillard, JY (Sep 2006). "Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial". Lancet Oncology. Elsevier. 7 (9): 719–727. PMID 16945766. Unknown parameter |coauthors= ignored (help)
  20. ↑ Tsuboi, M (Apr 2007). "The present status of postoperative adjuvant chemotherapy for completely resected non-small cell lung cancer" (PDF). Ann Thorac Cardiovasc Surg. 13 (2): 73–77. PMID 17505412. Retrieved 2007-08-14. Unknown parameter |coauthors= ignored (help)
  21. ↑ Horn, L (May 2007). "The rationale for adjuvant chemotherapy in stage I non-small cell lung cancer". Journal of Thoracic Oncology. 2 (5): 377–383. PMID 17473651. Unknown parameter |coauthors= ignored (help)
  22. ↑ Wakelee, HA (Jul 2006). "Current status of adjuvant chemotherapy for stage IB non-small-cell lung cancer: implications for the New Intergroup Trial". Clinical Lung Cancer. Cancer Information Group. 8 (1): 18–21. PMID 16870041. Unknown parameter |coauthors= ignored (help)
  23. ↑ BMJ (Dec 2005). Clinical Evidence Concise. BMJ Publishing Group. pp. 486–488. ISBN 1-905545-00-2. ISSN 1475-9225.

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