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How is it determined what chemotherapy agents are recommended for the different types of lung cancer?
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Expert Answers
BenjaminLevyMD (Physician - Oncology - Hematology/Oncology (Verified) ) - 02 / 16 / 2012
Chemotherapy for lung cancer has currently undergone several changes. The standard chemotherapy for patients with stage IV non-small cell lung cancer (NSCLC) is called a platinum doublet. That is either Carboplatin or Cisplatin in combination with another drug (generally the chemotherapy drugs taxol, gemcitabine, or pemetrexed).
However, recently, it appears that certain chemotherapy works better based on the subtype or histology of non small cell lung cancer that you have. This is called histology based treatment. Basically the data published suggested that if you select the chemotherpay based on histology, that patients do better. The two types of histologies of non-small cell lung cancer are adenocarcinoma and sqaumous cell. Based on recent data, it is my practice to give adenocarcinoma (the most common type) the following chemotherapy -- Cisplatin or Carboplatin in combination with a drug called Pemetrexed (Alimta). In addition, if adenocarcinoma, I generally add another drug called Avastin (for a total of three drugs). If patients have sqaumous cell, I generally offer Cisplatin or Carboplatin in combination with Gemcitabine. In summary, adenocarcinoma generally gets three drugs -- 1. Platinum (cisplatin or carboplatin), 2. Alimta and 3. Avastin (if elgible) and patients with sqaumous gets another (Cisplatin or Carboplatin) + Gemcitabine. Other acceptable standards include Platinum (Carboplatin or Cisplatin) + Taxol
Recently, there has been renewed interest to look at other markers (ERCC1, RRM, TS) in lung cancer to help select chemotherapy but thus far, this has not been proven to be better than the standard (these studies are ongoing). In mutational testing has become routine for patients who have adenocarcinoma. The two mutations that are tested for are the EGFR mutation and the ELM-4 mutation. Patient who have this mutation are generally offered oral drugs and not chemotherpay as discussed above
However, recently, it appears that certain chemotherapy works better based on the subtype or histology of non small cell lung cancer that you have. This is called histology based treatment. Basically the data published suggested that if you select the chemotherpay based on histology, that patients do better. The two types of histologies of non-small cell lung cancer are adenocarcinoma and sqaumous cell. Based on recent data, it is my practice to give adenocarcinoma (the most common type) the following chemotherapy -- Cisplatin or Carboplatin in combination with a drug called Pemetrexed (Alimta). In addition, if adenocarcinoma, I generally add another drug called Avastin (for a total of three drugs). If patients have sqaumous cell, I generally offer Cisplatin or Carboplatin in combination with Gemcitabine. In summary, adenocarcinoma generally gets three drugs -- 1. Platinum (cisplatin or carboplatin), 2. Alimta and 3. Avastin (if elgible) and patients with sqaumous gets another (Cisplatin or Carboplatin) + Gemcitabine. Other acceptable standards include Platinum (Carboplatin or Cisplatin) + Taxol
Recently, there has been renewed interest to look at other markers (ERCC1, RRM, TS) in lung cancer to help select chemotherapy but thus far, this has not been proven to be better than the standard (these studies are ongoing). In mutational testing has become routine for patients who have adenocarcinoma. The two mutations that are tested for are the EGFR mutation and the ELM-4 mutation. Patient who have this mutation are generally offered oral drugs and not chemotherpay as discussed above
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