Lung cancer medical therapy: Difference between revisions

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Revision as of 19:14, 21 July 2015

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

The medical therapy for lung cancer consists of surgery, radiation therapy, chemotherapy, and targeted therapy.

Surgery

To view the surgery of lung cancer, click here

Radiation Therapy

Radiation therapy can be given with either one of two methods:

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

Internal Radiation Therapy (brachytherapy)

This therapy involves placing a radioactive object in or near the tumor
This can shrink a tumor that blocks the airway

Possible side effects include the following:

Dry, sore, painful skin
Hair loss
Swelling of the lungs or esophagus
Fatigue
Loss of appetite

Chemotherapy

Non Small Cell Lung Cancer

Chemotherapy Regimens for Neoadjuvant 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
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 wks 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 nonsquamous (without specific histologic subtype), every 21 days for 4 cycles

Chemotherapy Regimens for Patients with Comorbidities or Patients Not Able to Tolerate Cisplatin

Paclitaxel 200 mg/m2 day 1, carboplatin AUC 6 day 1, every 21 days

Concurrent Chemotherapy and Radiation Therapy Regimens

Cisplatin 50 mg/m2 on days 1, 8, 29, and 36 AND etoposide 50 mg/m2 days 1-5, 29-33 WITH concurrent thoracic radiation therapy
Cisplatin 100 mg/m2 days 1 and 29 AND vinblastine 5 mg/m2/weekly x 5 WITH concurrent thoracic radiation therapy

Carboplatin AUC 5 on day 1 AND pemetrexed 500 mg/m2 on day 1 every 21 days for 4 cycles WITH concurrent thoracic radiation therapy

Cisplatin 75 mg/m2 on day 1 AND pemetrexed 500 mg/m2 on day 1 every 21 days for 3 cycles WITH concurrent thoracic radiation therapy

Sequential Chemotherapy and Radiation Therapy Regimens

Cisplatin 100 mg/m2 on days 1 and 29 AND vinblastine 5 mg/m2/weekly on days 1, 8, 15, 22, and 29 FOLLOWED by radiation therapy

Paclitaxel 200 mg/m2 over 3 hours on day 1 AND carboplatin AUC 6 over 60 minutes on day 1 every 3 weeks for 2 cycles FOLLOWED by thoracic radiation therapy

Concurrent Chemotherapy and Radiation Therapy Followed by Chemotherapy

8Paclitaxel 45-50 mg/m2 weekly AND carboplatin AUC 2 WITH concurrent thoracic radiation therapy FOLLOWED by 2 cycles of paclitaxel 200 mg/m2 and carboplatin AUC 6

Cisplatin 50 mg/m2 on days 1, 8, 29, and 36 AND etoposide 50 mg/m2 days 1-5, 29-33 WITH concurrent thoracic radiation therapy FOLLOWED by cisplatin 50 mg/m2 and etoposide 50 mg/m2 x 2

Targeted Therapy

Drug	Mechanism of Action	Common Side Effects
Afatinib	Blocks the signals from EGFRs to prevent cell growth	Diarrhea, skin problems, mouth sores, and lack of appetite
Bevacizumab	Stops the growth of new blood vessels	Diarrhea, high blood pressure, headache, fatigue, and mouth sores
Cetuximab	Attaches to EGFRs to prevent cell growth	Skin rash, fatigue, and weakness
Crizotinib	Block the signals from ALKs to prevent cell growth	Lack of appetite, nausea, vomiting, diarrhea, visual defects, and flu-like symptoms
Erlotinib hydrocholoride	Blocks the signals from EGFRs to prevent cell growth	Skin rash on face, neck, or trench within the first 2 weeks of treatment, diarrhea, fatigue, lack of appetite, and nausea

References

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 ====Non Small Cell Lung Cancer====
-Carboplatin
-Cisplatin
-Docetaxel
-Etoposide/etoposide phosphate
-Gemcitabine hydrochloride
-Ifosfamide
-Irinotecan hydrocholoride
-Mitomycin/mitomycin C
-Paclitaxel
-Paclitaxel albumin-bound
-Pemetrexed
-Vinorelbine tartrate
+=====Chemotherapy Regimens for Neoadjuvant 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
+*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 wks 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 nonsquamous (without specific histologic subtype), every 21 days for 4 cycles
-===Chemotherapy===
+=====Chemotherapy Regimens for Patients with Comorbidities or Patients Not Able to Tolerate Cisplatin=====
-Small cell lung carcinoma, even if relatively early stage, is treated primarily with chemotherapy and radiation<ref>{{cite journal|author=Hann CL, Rudin CM |title=Management of small-cell lung cancer: incremental changes but hope for the future |journal=Oncology (Williston Park)|date=2008 Nov 30|volume=22|issue=13|pages=1486–92}}</ref> as surgery has no demonstrable influence on survival. In small cell lung carcinoma, cisplatin and etoposide are most commonly used.<ref name="Murray">{{cite journal | last =Murray | first =N | coauthors =Turrisi AT | title =A review of first-line treatment for small-cell lung cancer | journal =Journal of Thoracic Oncology | volume =1 | issue =3 | pages =270–278 | date =Mar 2006 | pmid =17409868 }}</ref> Combinations with carboplatin, gemcitabine, paclitaxel, vinorelbine, [[topotecan]] and [[irinotecan]] are also used.<ref name="Azim">{{cite journal | last =Azim |first =HA | coauthors =Ganti AK | title =Treatment options for relapsed small-cell lung cancer | journal =Anticancer drugs | volume =18 | issue =3 | pages =255–261 | date =Mar 2007 | pmid =17264756 }}</ref><ref name="MacCallum">{{cite journal | last =MacCallum |first =C | coauthors = Gillenwater HH | title =Second-line treatment of small-cell lung cancer | journal =Current Oncology Reports |volume =8 | issue =4 | pages =258–264 | date =Jul 2006 | pmid =17254525 }}</ref> In extensive-stage small-cell lung cancer[[celecoxib]] may have a role.<ref name="pmid19266367">{{cite journal| author=Arúajo AM, Mendez JC, Coelho AL, Sousa B, Barata F, Figueiredo A et al.| title=Phase II study of celecoxib with cisplatin plus etoposide in extensive-stage small cell lung cancer. | journal=Cancer Invest | year= 2009 | volume= 27 | issue= 4 | pages= 391-6 | pmid=19266367 | doi=10.1080/07357900802232756 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19266367  }} </ref>
+*Paclitaxel 200 mg/m2 day 1, carboplatin AUC 6 day 1, every 21 days
-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]], or[[vinorelbine]].<ref name="Clegg">{{cite journal | last =Clegg | first =A | coauthors =Scott DA, Hewitson P et al. | title =Clinical and cost effectiveness of paclitaxel, docetaxel, gemcitabine, and vinorelbine in non-small cell lung cancer: a systematic review |journal =Thorax | volume =57 | issue =1 | pages =20–28 | publisher =BMJ Publishing Group Ltd | date =Jan 2002 | pmid =11809985}}</ref> [[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. <ref>{{cite journal |doi=10.1056/NEJMoa061884 |author=Sandler A, Gray R, Perry MC, et al. |title=Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer |journal=[[N Engl J Med]]|year=2006 |volume=355 |issue=24 |pages=2542–50 |pmid=17167137}}</ref> Bronchoalveolar carcinoma is a subtype of non-small cell lung carcinoma that may respond to [[gefitinib]]<ref>{{cite journal |doi=10.1200/JCO.2005.04.9890 |author=West HL, Franklin WA, McCoy J, et al. |title=Gefitinib therapy in advanced brochoalveolar carcinoma.  Southwest Oncology Group study S0126 |journal=[[J Clin Oncol]] |year=2006 |volume=24 |issue=12 |pages=1807–13 |pmid=16622257}}</ref> and [[erlotinib]].<ref>{{cite journal|doi=10.1200/JCO.2007.13.0062 |author=Miller VA, Riely GJ, Zakowski MF, et al. |title=Molecular characteristics of bronchoalveolar carcinoma and adenocarcinoma, brochoalveolar carcinoma subtype, predict response to erlotinib |journal=[[J Clin Oncol]] |year=2008|volume=26 |issue=9 |pages=1472–8 |pmid=18349398}}</ref>
+=====Concurrent Chemotherapy and Radiation Therapy Regimens=====
-Testing for the molecular genetic subtype of non-small cell lung cancer may be of assistance in selecting the most appropriate initial therapy<ref>{{cite journal |author=Aggarwal C et al. |title=Biomarkers with predictive and prognostic function in non-small cell lung cancer: ready for prime time? |journal=[[J Natl Compr Canc Netw]] |year=2010 |volume=8 |pages=822–32}}</ref> For example, mutation of the epidermal growth factor receptor gene<ref>{{cite journal |doi=10.1056/NEJMoa0904554 |last1=Rosell |first1=R|last2=Moran |first2=T |last3=Queralt |first3=C |last4=Porta |first4=R |last5=Cardenal |first5=F |last6=Camps |first6=C |last7=Majem|first7=M |last8=Lopez-Vivanco |first8=G |last9=Isla |first9=D |title=Screening for epidermal growth factor receptor mutations in lung cancer |journal=[[N Engl J Med]] |year=2009 |volume=361 |issue=10 |pages=958–67 |pmid=19692684}}</ref> may predict whether initial treatment with a specific inhibitor or with chemotherapy is more advantageous.<ref>{{cite journal |doi=10.1056/NEJMoa0810699|author=Mok TS et al. |title=Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma |journal=[[N Engl J Med]] |year=2009|volume=361 |issue=10 |pages=947–57 |pmid=19692680}}</ref>
+*Cisplatin 50 mg/m2 on days 1, 8, 29, and 36 AND etoposide 50 mg/m2 days 1-5, 29-33 WITH concurrent thoracic radiation therapy
+*Cisplatin 100 mg/m2 days 1 and 29 AND vinblastine 5 mg/m2/weekly x 5 WITH concurrent thoracic radiation therapy
-Maintenance therapy in advanced non-small cell lung cancer refers to continuing treatment after an initial response to therapy.<ref>{{cite journal |author=Eaton KD, Martins RG |title=Maintenance chemotherapy in non-small cell lung cancer |journal=[[J Natl Compr Canc Netw]] |date=2010 Jul |volume=8 |issue=7 |pages=815–21 |pmid=20679540}}</ref> Switch maintenance changes to different medications than the initial therapy and can use [[pemetrexed]],<ref>{{cite journal |doi=10.1016/S0140-6736(09)61497-5|author=Ciuleanu T, Brodowicz T, Zielinski C, et al. |title=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 |journal=[[Lancet]] |year=2009|volume=374 |pages=1432–40}}</ref> erlotinib,<ref>{{cite journal |doi=10.1016/S1470-2045(10)70112-1 |author=Cappuzzo F, Ciuleanu T, Stelmakh L, et al. |title=Erlotinib as maintenance treatment in advanced non-small-cell lung cancer: a multicentre, randomised, placebo-controlled phase 3 study |journal=[[Lancet|Lancet Oncol]] |year=2010 |volume=11 |pages=521–9}}</ref> and [[docetaxel]],<ref>{{cite journal |doi=10.1200/JCO.2008.17.1405 |author=Fidias PM, Dakhil SR, Lyss AP, et al. |title=Phase III study of immediate compared with delayed docetaxel after front-line therapy with gemcitabine plus carboplatin in advanced non-small-cell lung cancer |journal=[[J Clin Oncol]] |year=2009 |volume=27 |issue=4 |pages=591–8 |pmid=19075278}}</ref> although pemetrexed is only used in non-squamous NSCLC.<ref>{{cite journal |doi=10.1016/j.lungcan.2009.06.006 |author=Rossi A, Ricciardi S, Maione P, de Marinis F, Gridelli C |journal=[[Lung Cancer (journal)|Lung Cancer]] |year=2009 |volume=66 |issue=2 |pages=141–9 |title=Pemetrexed in the treatment of advanced non-squamous lung cancer |pmid=19577816}}</ref>
+*Carboplatin AUC 5 on day 1 AND pemetrexed 500 mg/m2 on day 1 every 21 days for 4 cycles WITH concurrent thoracic radiation therapy
-==== Adjuvant chemotherapy for non-small cell lung carcinoma====
+*Cisplatin 75 mg/m2 on day 1 AND pemetrexed 500 mg/m2 on day 1 every 21 days for 3 cycles WITH concurrent thoracic radiation therapy
+=====Sequential Chemotherapy and Radiation Therapy Regimens=====
+*Cisplatin 100 mg/m2 on days 1 and 29 AND vinblastine 5 mg/m2/weekly on days 1, 8, 15, 22, and 29 FOLLOWED by radiation therapy
+*Paclitaxel 200 mg/m2 over 3 hours on day 1 AND carboplatin AUC 6 over 60 minutes on day 1 every 3 weeks for 2 cycles FOLLOWED by thoracic radiation therapy
+=====Concurrent Chemotherapy and Radiation Therapy Followed by Chemotherapy=====
+Paclitaxel 45-50 mg/m2 weekly AND carboplatin AUC 2 WITH concurrent thoracic radiation therapy FOLLOWED by 2 cycles of paclitaxel 200 mg/m2 and carboplatin AUC 6
+*Cisplatin 50 mg/m2 on days 1, 8, 29, and 36 AND etoposide 50 mg/m2 days 1-5, 29-33 WITH concurrent thoracic radiation therapy FOLLOWED by cisplatin 50 mg/m2 and etoposide 50 mg/m2 x 2
 ===Targeted Therapy===