Non small cell lung cancer medical therapy stage IV
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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] Maria Fernanda Villarreal, M.D. [3]
Overview
Therapies for non-small cell lung cancer stage IV, include: Local therapies (ambulatory catheter drainage, pleurodesis or mediastinal window) plus therapy for systemic metastasis is the preferred combination for patients with stage IV M1a non small cell lung cancer. Patients with solitary site metastasis (stage IV M1b) should be treated according to the site of metastasis.
Medical Therapy for Stage IV Non-Small Cell Lung Cancer
The algorithms for the treatment of stage IV non small cell carcinoma of the lung are based on the 2014 NCCN Non-Small Cell Lung Cancer guidelines.[1]
Is pleural or pericardial effusion present (suggestive of M1a) or are findings suggestive of systemic metastasis (M1b) present? | |||||||||||||||||||||||||||||||||||||||||||||
M1a | M1b: solitary site systemic metastasis | ||||||||||||||||||||||||||||||||||||||||||||
Perform the following tests:
| Perform the following tests:
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Is the liquid extracted positive for malignant cells? | Are findings suggestive of adrenal metastasis or brain metastasis? | ||||||||||||||||||||||||||||||||||||||||||||
Yes | No | Adrenal | Brain | ||||||||||||||||||||||||||||||||||||||||||
Local therapy
PLUS | Perform a needle aspiration biopsy for metastasis confirmation | Surgical resection + adjuvant radiation therapy Radiation therapy alone:
PLUS | |||||||||||||||||||||||||||||||||||||||||||
If the lung disease is curable, administer local therapy for the adrenal lesion:
OR | What is the TN stage of the lung tumor? | ||||||||||||||||||||||||||||||||||||||||||||
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| Administer therapy for metastatic disease in case of not curable lung lesions (click here for the treatment of metastatic cancer) | ||||||||||||||||||||||||||||||||||||||||||||