Large cell carcinoma of the lung medical therapy: Difference between revisions
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*Preferred regimen (1) : [[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 | *Preferred regimen (1) : [[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 | ||
*Preferred regimen (2) : [[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 | *Preferred regimen (2) : [[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 | ||
==Complications== | ==Complications== | ||
Revision as of 23:29, 2 March 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
Combination chemotherapy regimens using platinum-based chemotherapy and specific-inhibitors is the treatment of choice for the management of patients with large cell carcinoma of the lung. Chemotherapy may be required upon histological subtype of large cell carcinoma of the lung, molecular testing (presence of genetic mutations), and staging. In most cases, the predominant treatment of choice for large cell carcinoma of the lung is neoadjuvant chemotherapy or adjuvant chemotherapy, followed or preceded by surgical resection. There is no consensus on treatment in patients with large cell lung neuroendocrine carcinoma. Commonly used chemotherapeutic agents, include: cisplatin, erlotinib, paclitaxel, docetaxel, carboplatin, etoposide or vinorelbine.
Medical Therapy
- Initial chemotherapy for patients with large cell carcinoma of the lung will depend on molecular testing, the presence of particular genetic mutations, and staging.
- Chemotherapy for patients with large cell carcinoma of the lung, is divided into 2 main types:
- Specific-inhibitor therapy (usually indicated with the presence of a genetic mutation).
- 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 large cell carcinoma of the lung.
- Erlotinib is the first-line treatment for patients with large 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.
- Platinum-based chemotherapy (cisplatin, carboplatin, etoposide, irinotecan) are the mainstay of large 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
- Chemotherapy treatments for large cell carcinoma of the lung, include:[1][2][3]
Chemotherapy Regimens for Neoadjuvant and Adjuvant Therapy[4]
- Preferred regimen (1) : Cisplatin 50 mg/m2 days 1 and 8 and vinorelbine 25 mg/m2 days 1, 8, 15, 22, every 28 days for 4 cycles
- Preferred regimen (2) : Cisplatin 100 mg/m2 day 1 and vinorelbine 30 mg/m2 days 1, 8, 15, 22, every 28 days for 4 cycles
- Preferred regimen (3) : Cisplatin 75-80 mg/m2 day 1 and vinorelbine 25-30 mg/m2 days 1 + 8, every 21 days for 4 cycles
- Preferred regimen (4) : Cisplatin 100 mg/m2 day 1 and etoposide 100 mg/m2 days 1-3, every 28 days for 4 cycles
- Preferred regimen (5) : 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
- Preferred regimen (6) : Cisplatin 75 mg/m2 day 1 and gemcitabine 1250 mg/m2 days 1, 8, every 21 days for 4 cycles
- Preferred regimen (7) : Cisplatin 75 mg/m2 day 1 and docetaxel 75 mg/m2 day 1, every 21 days for 4 cycles
- Preferred regimen (8) : 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[5]
- Preferred regimen (1) : Paclitaxel 200 mg/m2 day 1, carboplatin AUC 6 day 1, every 21 days
Concurrent Chemotherapy and Radiation Therapy Regimens[6]
- Preferred regimen (1) : 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
- Preferred regimen (2) : Cisplatin 100 mg/m2 days 1 and 29 and vinblastine 5 mg/m2/weekly x 5 with concurrent thoracic radiation therapy
- Preferred regimen (3) : 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
- Preferred regimen (4) : 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[7]
- Preferred regimen (1) : 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
- Preferred regimen (2) : 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[8]
- Preferred regimen (1) : 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
- Preferred regimen (2) : 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
Complications
- Medical therapy complications for large cell carcinoma of the lung will depend on the chemotherapeutic agent.
- Common chemotherapy complications, include:[1]
- 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:
References
- ↑ 1.0 1.1 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
- ↑ Ishii K, Ishii N, Shigenobu K, Kasuya Y (1985). "Acetylcholine supersensitivity in the rat heart produced by neonatal sympathectomy". Can. J. Physiol. Pharmacol. 63 (7): 898–9. PMID 4042022.
- ↑ 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
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf
- ↑ http://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf