Lung cancer medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Saarah T. Alkhairy M.D

Overview

Medical therapy for lung cancer consists of radiation therapy, chemotherapy, and targeted therapy.

Medical Therapy

The table below summarizes the treatment for each stage of lung cancer for those who either refuse or unable to tolerate surgery.

Stage	Treatment
I	Radiation therapy AND consider chemotherapy for high risk stage IB
II (T2a, N0 OR T3, N0)	Consider chemotherapy for high risk stage II AND radiation therapy
II (T1a, N1 OR T1b, N1 OR T2a, N1 OR T2b, N1)	Chemo-radiation
III	Chemo-radiation

The algorithm below demonstrates a treatment protocol for patients with stage I who can tolerate surgery: ^[1].

The algorithm below demonstrates a treatment protocol for patients with stage II without invasion who can tolerate surgery: ^[2]

The algorithm below demonstrates a treatment protocol for patients with stage II with invasion who can tolerate surgery: ^[3]

The algorithm below demonstrates a treatment protocol for patients with stage III without invasion who can tolerate surgery: ^[4]^[5]

The algorithm below demonstrates a treatment protocol for patients with stage III with invasion who can tolerate surgery: ^[6]^[7]

The treatment of stage 4 lung cancers includes chemotherapy if the Eastern Cooperative Oncology Group (ECOG) Performance Scale is between 0 and 2. If the Performance Score is 3 or 4, then supportive care is recommended. ^[8]

The Eastern Cooperative Oncology Group (ECOG) Performance Scale is the following: ^[9]

- 0: Fully active
- 1: Self-care activities but unable to do hard physical work
- 2: Self-care activities but unable to do any work
- 3: Unable to do any self-care activities or any work
- 4: Fully disabled

Surgery

To learn about the surgical approach to lung cancer, click here.

Radiation Therapy

Radiation therapy can be administered via the following two methods:

1. 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

2. Internal Radiation Therapy (Brachytherapy)

This approach involves placing a radioactive object in or near the tumor
This can shrink an airway blocking tumor

Possible side effects include the following:

Chemotherapy for Non Small Cell Lung Cancer

Chemotherapy Regimens as Neo-adjuvant 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^[10]
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 weeks 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 non-squamous (without specific histologic sub-type), 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 ^[11]

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^[12]
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 ^[13]
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 ^[14]
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

Chemotherapy for Non Small Cell Lung Cancer

Chemotherapy as Primary or Adjuvant Therapy^[15]

Limited Stage (Maximum of 4 - 6 cycles):

Cisplatin 60 mg/m² day 1 AND etoposide 120 mg/m² days 1, 2, 31
Cisplatin 80 mg/m² day 1 AND etoposide 100 mg/m² days 1, 2, 32
Carboplatin AUC 5 - 6 day 1 AND etoposide 100 mg/m² days 1, 2, 33

Extensive Stage (Maximum of 4 - 6 cycles):

Cisplatin 75 mg/m² day 1 AND etoposide 100 mg/m² days 1, 2, 3
Cisplatin 80 mg/m² day 1 AND etoposide 80 mg/m² days 1, 2, 3
Cisplatin 25 mg/m² days 1, 2, 3 AND etoposide 100 mg/m² days 1, 2, 3
Carboplatin AUC 5 - 6 day 1 AND etoposide 100 mg/m² days 1, 2, 3
Cisplatin 60 mg/m² day 1 AND irinotecan 60 mg/m² days 1, 8, 15
Cisplatin 30 mg/m² AND irinotecan 65 mg/m² days 1, 89
Carboplatin AUC 5 day 1 and irinotecan 50 mg/m² days 1, 8, 15

Subsequent Chemotherapy (Relapse < 2 - 3 Months)

Subsequent Chemotherapy (Relapse > 2 - 3 Months up to 6 Months)

Subsequent Chemotherapy (Relapse > 6 Months)

Original regimen^[18]

Targeted Therapy

Targeted therapy treats selected lung cancers or is combined with chemotherapy.
It is less likely to harm normal cells compared to chemotherapy.

The table below summarizes the targeted therapy drugs' mechanism of action and common side effects: ^[19]

Drug	Mechanism of Action	Common Side Effects
Afatinib	Blocks the signals from EGFR 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 EGFR to prevent cell growth	Skin rash, fatigue, and weakness
Crizotinib	Block the signals from anaplastic lymphoma kinase to prevent cell growth	Lack of appetite, nausea, vomiting, diarrhea, visual defects, and flu-like symptoms
Erlotinib hydrocholoride	Blocks the signals from EGFR to prevent cell growth	Skin rash on face, neck, or trunk within the first 2 weeks of treatment, diarrhea, fatigue, lack of appetite, and nausea

References

Template:Tumors

Template:WikiDoc Sources

[1] ttp://www.nccn.org/patients/guidelines/nscl/#56/z

[2] ttp://www.nccn.org/patients/guidelines/nscl/#58/z

[3] ttp://www.nccn.org/patients/guidelines/nscl/#61/z

[4] ttp://www.nccn.org/patients/guidelines/nscl/#63/z

[5] ttp://www.nccn.org/patients/guidelines/nscl/#64/z

[6] ttp://www.nccn.org/patients/guidelines/nscl/#66/z

[7] ttp://www.nccn.org/patients/guidelines/nscl/#67/z

[8] ttp://www.nccn.org/patients/guidelines/nscl/#72/z

[9] ttp://www.nccn.org/patients/guidelines/nscl/#71/z

[10] ttp://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf

[11] ttp://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf

[12] ttp://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf

[13] ttp://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf

[14] ttp://www.nccn.org/professionals/physician_gls/PDF/nscl.pdf

[15] ttp://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf

[16] ttp://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf

[17] ttp://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf

[18] ttp://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf

[19] ttp://www.nccn.org/patients/guidelines/nscl/#51/z

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Lung cancer medical therapy

Overview

Medical Therapy

Surgery

Radiation Therapy

1. External Beam Radiation Therapy (EBRT)

2. Internal Radiation Therapy (Brachytherapy)

Chemotherapy for Non Small Cell Lung Cancer

Chemotherapy Regimens as Neo-adjuvant and Adjuvant Therapy

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

Concurrent Chemotherapy and Radiation Therapy Regimens

Sequential Chemotherapy and Radiation Therapy Regimens

Concurrent Chemotherapy and Radiation Therapy Followed by Chemotherapy

Chemotherapy for Non Small Cell Lung Cancer

Chemotherapy as Primary or Adjuvant Therapy[15]

Subsequent Chemotherapy (Relapse < 2 - 3 Months)

Subsequent Chemotherapy (Relapse > 2 - 3 Months up to 6 Months)

Subsequent Chemotherapy (Relapse > 6 Months)

Targeted Therapy

The table below summarizes the targeted therapy drugs' mechanism of action and common side effects: [19]

References

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Chemotherapy as Primary or Adjuvant Therapy^[15]

The table below summarizes the targeted therapy drugs' mechanism of action and common side effects: ^[19]