Non-Small-Cell Lung Cancer (cont.)
Koyamangalath Krishnan, MD, FRCP
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 white blood cell count). Because neutropenia increases the risk of infections, antibiotics may also be given. Growth factors are often given to promote the production of 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:
- Cisplatin (Platinol): This agent damages the DNA of the tumor cells. It can also damage healthy cells, which accounts for some of the side effects such as hair loss and nausea. This drug can be harmful to the kidneys and must be given with extreme caution to people with kidney problems. It also can damage the ears and diminish hearing.
- Carboplatin (Paraplatin): This drug is similar to cisplatin but generally causes fewer side effects.
- Vinorelbine (Navelbine): This agent stops tumor cell growth by interfering with cell division.
- Paclitaxel (Taxol): This drug also interferes with cell division.
- Gemcitabine (Gemzar): This drug interferes with formation of DNA in cells so they cannot reproduce.
- Docetaxel (Taxotere): This agent prevents cell division by interfering with the cell’s preparations to divide.
Gefitinib (Iressa) and erlotinib (Tarceva): These are new drugs used to treat advanced NSCLC that is resistant to more conventional chemotherapy agents. These drugs are referred to as tyrosine kinase inhibitors. They inhibit the activity of a substance called epidermal growth factor receptor tyrosine kinase, which is located on the surface of cells and is needed for growth.
- A large clinical trial comparing gefitinib (Iressa) with placebo (sugar pills) showed no advantage in survival for people with non -small-cell lung cancer. People currently taking gefitinib should consult with their doctor as soon as possible to determine if an alternative therapy is necessary. However, several groups of people within the overall population studied showed a positive response to gefitinib. The populations who responded to gefitinib were more likely to be women of Asian ancestry who have never smoked. Gefitinib was approved based on data from clinical trials that showed tumor shrinkage in about 10% of people and improving symptoms in another 40% of people.
- See Drug Recalls and Alerts (12/17/2004) for more information.
- Pemetrexed disodium (Alimta): This agent disrupts metabolic processes essential for cell production.
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