Non-Small-Cell Lung Cancer (cont.)
IN THIS ARTICLE
The 3 major therapies used in NSCLC are surgery, chemotherapy, and radiation therapy. A newer fourth therapy, laser therapy, is becoming more widely used.
Each person with NSCLC should be offered a customized treatment regimen, which should consist of some combination of these therapies depending on disease stage and location.
After the staging evaluation, a decision is made whether the tumor is operable. Operable (or resectable) tumors are those that can be removed completely or almost completely by surgery. Generally, only stage I and some stage II and III tumors can be removed by surgery. Sometimes, people with stage III or IV inoperable disease undergo surgery, but this is usually performed to remove enough of the tumor to relieve symptoms such as breathing problems or severe pain. Surgery does not cure people with stage IV or most stage III diseases. For more information see Surgery.
NSCLC is only moderately sensitive to chemotherapy. Chemotherapy alone does not have the potential to cure people with NSCLC. When the goal is cure, chemotherapy is given in combination with surgery or radiation therapy. Chemotherapy alone is given only to people who cannot undergo surgery or radiation therapy or, in some cases, people whose disease has relapsed after surgery. When given in combination with surgery, the chemotherapy is usually given after surgery (adjuvant chemotherapy). Adjuvant chemotherapy is recommended to treat cancer in stages I-III after surgery has been performed to remove the cancer. Before beginning treatment, the patient undergoes testing to determine the extent of her disease. In general, chemotherapy is given in cycles. Treatment usually lasts a few days and is then followed by a recovery period of a few weeks. When side effects have subsided and blood cell counts have started to return to normal, the next cycle begins. Usually, chemotherapy is given in regimens of 2 or 4 cycles. After these cycles are over, the patient undergoes repeat CT scans and other tests to see what effect the chemotherapy has had on the tumor.
Radiation therapy may be given in combination with surgery or chemotherapy or alone. Generally, radiation therapy is given alone only for persons who are not candidates for surgery.
Inoperable NSCLC is treated with chemotherapy or a combination of chemotherapy and radiation therapy. Chemotherapy usually requires other supportive medications to prevent or treat side effects such as nausea and vomiting, anemia (low red blood cell count), bleeding (from low platelet count), and neutropenia (low numbers of infection-fighting types of white blood cells called neutrophils). Because neutropenia increases the risk of infections, antibiotics may also be given. Growth factors are often given to promote the production of red and white blood cells and platelets. The agents most widely used to prevent or treat nausea and vomiting are corticosteroids (dexamethasone [Decadron]) and the serotonin receptor antagonists, which include ondansetron (Zofran), granisetron (Kytril), and dolasetron (Anzemet). For more information, see Understanding Lung Cancer Medications.
The chemotherapy agents that are currently used to treat NSCLC include the following:
Crizotinib and Ceritinib are new oral targeted agents that can help to treat NSCLC when mutations in other genes in the cancer cells are detected.
Medically Reviewed by a Doctor on 9/11/2014
Irfan Maghfoor, MD
Michael Perry, MD, FACP
Winston W Tan, MD
Mary L Windle, PharmD
Koyamangalath Krishnan, MD, FRCP
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