Lung cancer medical therapy


 * Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA,

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

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

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. 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. Bronchoalveolar carcinoma is a subtype of non-small cell lung carcinoma that may respond to gefitinib and erlotinib.

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

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

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%. Standard practice is to offer platinum-based chemotherapy (including either cisplatin or carboplatin).

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