For stage 4 adenocarcinoma non small cell lung cancer (NSCLC), what is the standard first line of treatment?

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JoanSchillerMD (Physician (Verified) ) - 09 / 22 / 2012

It depends upon whether or not the tumor has a EGFR mutation or anther type of mutation called the EML4/ALK fusion protein, since there are drugs designed very specifically for these mutations. However, these mutations only occur in roughly 20% - 25% of all adenocarcinomas, so the majority of patients will not have them. Nevertheless, ask your doctor if he or she has tested your tumor for them.

Generally speaking, chemotherapy for patients with Stage IV NSCLC usually involves a combination of two drugs (a doublet). In the past, one of the two drugs has been a platin, such as cisplatin or carboplatin (commonly called a platin doublet), although this does not necessarily have to be the case. There are an number of drugs which can be combined with the platin. These include paclitaxel (Taxol); docetaxel (Taxotere); pemetrexed (Alimta); or gemcitabine (Gemzar). The different two drug regimens differ in how frequently they are given (the schedule), how much they cost, and their side effects. As mentioned in this answer (, pemetrexed is slightly more effective in adenocarcinomas than non-adenocarcinomas.

Bevacizumab (Avastin) is a drug which is designed to stop the growth of new blood vessels, thus “choking off” the blood supply to the tumor. It is approved for use with the doublet chemotherapy carboplatin/paclitaxel (sometimes called Carbo/Taxol) in patients with non-squamous cell cancers only, since it caused increased bleeding in patients with squamous cell.

Typically, doublet chemotherapy is given 4 – 6 times (also called cycles) and then stopped, to give the patient a “chemo break.” More recently, there is some data to suggest that continuing one drug (maintenance therapy) until progression may be helpful.
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