Non-small cell lung cancer

Adjuvant therapy

Cisplatin (Platinol) & Vinorelbine (Navelbine) #1

Regimen

• Cisplatin (Platinol) 50 mg/m2 IV on days 1 & 8
• Vinorelbine (Navelbine) 25 mg/m2 IV on days 1, 8, 15, 22

28-day cycles x 4 cycles

Cisplatin (Platinol) & Vinorelbine (Navelbine) #2

Regimen

• Cisplatin (Platinol) 75-80 mg/m2 IV on day 1
• Vinorelbine (Navelbine) 25-30 mg/m2 IV on days 1, 8

21-day cycles x 4 cycles

Cisplatin (Platinol) & Vinorelbine (Navelbine) #3

Regimen

• Cisplatin (Platinol) 100 mg/m2 IV on day 1
• Vinorelbine (Navelbine) 30 mg/m2 IV on days 1, 8, 15, 22

28-day cycles x 4 cycles

Cisplatin (Platinol) & Etoposide (Vepesid)

Regimen

• Cisplatin (Platinol) 100 mg/m2 IV on day 1
• Etoposide (Vepesid) 100 mg/m2 IV on days 1-3

28-day cycles x 4 cycles

Cisplatin (Platinol) & Vinblastine (Velban)

Regimen

• Cisplatin (Platinol) 80 mg/m2 IV on day 1
• Vinblastine (Velban) 4 mg/m2 IV on days 1, 8, 15 of cycle 1

• Vinblastine (Velban) 4 mg/m2 IV on days 1 & 8 of cycle 2
• Vinblastine (Velban) 4 mg/m2 IV on days 1 & 15 of cycle 3
• Vinblastine (Velban) 4 mg/m2 IV on day 8 of cycle 4

Note: The above vinblastine schedule is based on it being given as described every 2 weeks after cycle 2 day 8

21-day cycles x 4 cycles

Cisplatin (Platinol) & Gemcitabine (Gemzar)

Regimen

• Cisplatin (Platinol) 75 mg/m2 IV on day 1
• Gemcitabine (Gemzar) 1250 mg/m2 IV on days 1, 8

21-day cycles x 4 cycles

Cisplatin (Platinol) & Docetaxel (Taxotere)

Regimen

• Cisplatin (Platinol) 75 mg/m2 IV day 1
• Docetaxel (Taxotere) 75 mg/m2 IV day 1

21-day cycles x 4 cycles

Cisplatin (Platinol) & Pemetrexed (Alimta)

Regimen

• Cisplatin (Platinol) 75 mg/m2 IV day 1
• Pemetrexed (Alimta) 500 mg/m2 IV day 1

21-day cycles x 4 cycles

Carboplatin (Paraplatin) & Paclitaxel (Taxol)

Regimen

• Carboplatin (Paraplatin) AUC 6 IV day 1
• Paclitaxel (Taxol) 200 mg/m2 IV day 1

21-day cycles x 4 cycles

Chemotherapy & radiation therapy

Concurrent RT with Cisplatin (Platinol) & Etoposide (Vepesid)

Regimen

• Cisplatin (Platinol) 50 mg/m2 IV on days 1, 8, 29, 36
• Etoposide (Vepesid) 50 mg/m2 IV on days 1-5, 29-33
• Concurrent radiation therapy (start within 24 hours of chemotherapy, 1.8 Gy per day, 5 days per week; 25 fractions given over 5 weeks total for a total of 45 Gy)

5-week initial course of chemotherapy & radiation, THEN

• Patients reimaged with CT scan (bone scan and head imaging were only done if patients had new symptoms), and those without progression or new metastatic disease received an additional 2 Gy per day x 8 fractions for a total of 61 Gy administered overall

References

1. Albain KS, Crowley JJ, Turrisi AT 3rd, Gandara DR, Farrar WB, Clark JI, Beasley KR, Livingston RB. Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: a Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol. 2002 Aug 15;20(16):3454-60. link to original article contains protocol PubMed

Concurrent RT with Cisplatin (Platinol) & Vinblastine (Velban)

Regimen

• Cisplatin (Platinol) 100 mg/m2 IV on days 1 & 29
• Vinblastine (Velban) 5 mg/m2 IV on days 1, 8, 15, 22, 29
• Concurrent radiation therapy

5-week total course of chemotherapy

Concurrent RT with Carboplatin (Paraplatin) & Paclitaxel (Taxol)

Regimen

• Carboplatin (Paraplatin) AUC 2 IV over 30 minutes days 1, 8, 15 (administered second)
• Paclitaxel (Taxol) 45 mg/m2 IV over 1 hour day 1, 8, 15 (administered first)
• Concurrent radiation therapy given:

• 1.8 Gy daily, 5 days per week; 25 fractions given over 5 weeks with 45 Gy overall dose, then
• 2 Gy daily, 5 days per week; 9 additional fractions with an extra 18 Gy given for a total of 63 Gy over a total 7 week course of treatment

21-day cycles x 2 cycles. Note: This regimen is listed in the NCCN guidelines, but it is not what was described in the Belani, et al. paper below. In that paper, additional consolidation chemotherapy was given after concurrent chemotherapy & radiation therapy was completed--that regimen is listed below.

References

1. Belani CP, Choy H, Bonomi P, Scott C, Travis P, Haluschak J, Curran WJ Jr. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol. 2005 Sep 1;23(25):5883-91. link to original article contains protocol PubMed

Sequential RT with Cisplatin (Platinol) & Vinblastine (Velban)

Regimen

• Cisplatin (Platinol) 100 mg/m2 IV on days 1 & 29
• Vinblastine (Velban) 5 mg/m2 IV on days 1, 8, 15, 22, 29
• Radiation therapy given after chemotherapy is complete

5-week total course of chemotherapy

Sequential RT with Carboplatin (Paraplatin) & Paclitaxel (Taxol)

Regimen

• Carboplatin (Paraplatin) AUC 6 IV over 30 minutes day 1 (administered second)
• Paclitaxel (Taxol) 200 mg/m2 IV over 3 hours day 1 (administered first)

21-day cycles x 2 cycles

• Radiation therapy given after chemotherapy is complete:

• 1.8 Gy daily, 5 days per week; 25 fractions given over 5 weeks with 45 Gy overall dose, then
• 2 Gy daily, 5 days per week; 9 additional fractions with an extra 18 Gy given for a total of 63 Gy over a total 7 week course of treatment

References

1. Belani CP, Choy H, Bonomi P, Scott C, Travis P, Haluschak J, Curran WJ Jr. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol. 2005 Sep 1;23(25):5883-91. link to original article contains protocol PubMed

Concurrent RT with Cisplatin (Platinol) & Etoposide (Vepesid), then consolidation chemo

Regimen

• Cisplatin (Platinol) 50 mg/m2 IV on days 1, 8, 29, 36
• Etoposide (Vepesid) 50 mg/m2 IV on days 1-5, 29-33
• Concurrent radiation therapy (start within 24 hours of chemotherapy, 1.8 Gy per day, 5 days per week; 25 fractions given over 5 weeks total for a total of 45 Gy)

5-week initial course of chemotherapy & radiation, THEN

• Patients reimaged with CT scan (bone scan and head imaging were only done if patients had new symptoms), and those without progression or new metastatic disease received an additional 2 Gy per day x 8 fractions for a total of 61 Gy administered overall

Additional chemotherapy:

• Cisplatin (Platinol) 50 mg/m2 IV on days 1 & 8
• Etoposide (Vepesid) 50 mg/m2 IV on days 1-5

28-day cycles x 2 cycles. Note: "two extra cycles" of chemotherapy are listed as an option in the NCCN guidelines, but I have not been able to find a reference in the primary literature that describes this regimen, nor whether it is two cycles of the initial ~5-week cycle, or whether 28-day cycles are supposed to be used.

References

1. Albain KS, Crowley JJ, Turrisi AT 3rd, Gandara DR, Farrar WB, Clark JI, Beasley KR, Livingston RB. Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: a Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol. 2002 Aug 15;20(16):3454-60. link to original article contains protocol, but not for additional chemotherapy PubMed

Concurrent RT with Carboplatin (Paraplatin) & Paclitaxel (Taxol), then consolidation chemo

Regimen

• Carboplatin (Paraplatin) AUC 2 IV over 30 minutes days 1, 8, 15 (administered second)
• Paclitaxel (Taxol) 45 mg/m2 IV over 1 hour day 1, 8, 15 (administered first)
• Concurrent radiation therapy given:

• 1.8 Gy daily, 5 days per week; 25 fractions given over 5 weeks with 45 Gy overall dose, then
• 2 Gy daily, 5 days per week; 9 additional fractions with an extra 18 Gy given for a total of 63 Gy over a total 7 week course of treatment

21-day cycles x 2 cycles, THEN

• Carboplatin (Paraplatin) AUC 6 IV over 30 minutes day 1 (administered second)
• Paclitaxel (Taxol) 200 mg/m2 IV over 3 hours day 1 (administered first)

21-day cycles x 2 cycles

References

1. Belani CP, Choy H, Bonomi P, Scott C, Travis P, Haluschak J, Curran WJ Jr. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol. 2005 Sep 1;23(25):5883-91. link to original article contains protocol PubMed

Advanced or metastatic disease

Cisplatin (Platinol) & Paclitaxel (Taxol)

Regimen

• Paclitaxel (Taxol) 135 mg/m2 IV over 24 hours day 1
• Cisplatin (Platinol) 75 mg/m2 IV day 2

21-day cycles

References

1. Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, Zhu J, Johnson DH; Eastern Cooperative Oncology Group. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002 Jan 10;346(2):92-8. link to original article contains protocol PubMed

Cisplatin (Platinol) & Docetaxel (Taxotere)

Regimen

• Cisplatin (Platinol) 75 mg/m2 IV day 1
• Docetaxel (Taxotere) 75 mg/m2 IV day 1

21-day cycles

References

1. Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, Zhu J, Johnson DH; Eastern Cooperative Oncology Group. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002 Jan 10;346(2):92-8. link to original article contains protocol PubMed

Cisplatin (Platinol) & Pemetrexed (Alimta)

Regimen

• Cisplatin (Platinol) 75 mg/m2 IV day 1
• Pemetrexed (Alimta) 500 mg/m2 IV day 1
• Cyanocobalamin (vitamin B12) 1000mcg IM every 9 weeks, first dose prior to pemetrexed
• Folic acid 1mg PO daily

21-day cycles

Cisplatin (Platinol) & Gemcitabine (Gemzar)

Regimen

• Cisplatin (Platinol) 100 mg/m2 IV day 1
• Gemcitabine (Gemzar) 1000 mg/m2 IV days 1, 8, 15

28-day cycles

References

1. Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, Zhu J, Johnson DH; Eastern Cooperative Oncology Group. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002 Jan 10;346(2):92-8. link to original article contains protocol PubMed

Carboplatin (Paraplatin) & Paclitaxel (Taxol)

Regimen

• Carboplatin (Paraplatin) AUC 6 IV day 1 (administer second)
• Paclitaxel (Taxol) 200-225 mg/m2 IV over 3 hours on day 1 (administer first)

21-day cycles

References

1. Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, Zhu J, Johnson DH; Eastern Cooperative Oncology Group. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002 Jan 10;346(2):92-8. link to original article contains protocol PubMed

Carboplatin (Paraplatin), Paclitaxel (Taxol), Bevacizumab (Avastin)

Regimen

• Carboplatin (Paraplatin) AUC 6 IV day 1 (administer second)
• Paclitaxel (Taxol) 200-225 mg/m2 IV over 3 hours on day 1 (administer first)
• Bevacizumab (Avastin) 15 mg/kg IV day 1

21-day cycles

Carboplatin (Paraplatin) & Docetaxel (Taxotere)

Regimen

• Carboplatin (Paraplatin) AUC 6 IV day 1
• Docetaxel (Taxotere) 75 mg/m2 IV day 1

21-day cycles

Carboplatin (Paraplatin) & Pemetrexed (Alimta)

Regimen

• Carboplatin (Paraplatin) AUC 6 IV day 1
• Pemetrexed (Alimta) 500 mg/m2 IV day 1
• Cyanocobalamin (vitamin B12) 1000mcg IM every 9 weeks, first dose prior to pemetrexed
• Folic acid 1mg PO daily

21-day cycles

Carboplatin (Paraplatin) & Gemcitabine (Gemzar)

Regimen

• Carboplatin (Paraplatin) AUC 5 IV day 1
• Gemcitabine (Gemzar) 1250 mg/m2 IV days 1 & 8

21-day cycles

Docetaxel (Taxotere)

Regimen

• Docetaxel (Taxotere) 75 mg/m2 IV day 1

21-day cycles

Pemetrexed (Alimta)

Regimen

• Pemetrexed (Alimta) 500 mg/m2 IV day 1
• Cyanocobalamin (vitamin B12) 1000mcg IM every 9 weeks, first dose prior to pemetrexed
• Folic acid 1mg PO daily

21-day cycles

Erlotinib (Tarceva)

• Erlotinib (Tarceva) 150 mg PO daily

Gefitinib (Iressa)

• Gefitinib (Iressa) 250 mg PO daily