Non-small cell lung cancer

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Adjuvant therapy

Carboplatin (Paraplatin) & Paclitaxel (Taxol)

Regimen

• Carboplatin (Paraplatin) AUC 6 IV over 45-60 minutes day 1
• Paclitaxel (Taxol) 200 mg/m2 IV over 3 hours day 1

21-day cycles x 4 cycles

References

1. Strauss GM, Herndon JE 2nd, Maddaus MA, Johnstone DW, Johnson EA, Harpole DH, Gillenwater HH, Watson DM, Sugarbaker DJ, Schilsky RL, Vokes EE, Green MR. Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol. 2008 Nov 1;26(31):5043-51. Epub 2008 Sep 22. 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 x 4 cycles

• Example orders for adjuvant Cisplatin (Platinol) and Docetaxel (Taxotere) in non-small cell lung cancer

References

1. Fossella F, Pereira JR, von Pawel J, Pluzanska A, Gorbounova V, Kaukel E, Mattson KV, Ramlau R, Szczesna A, Fidias P, Millward M, Belani CP. Randomized, multinational, phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for advanced non-small-cell lung cancer: the TAX 326 study group. J Clin Oncol. 2003 Aug 15;21(16):3016-24. Epub 2003 Jul 1. link to original article contains protocol PubMed

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

References

1. Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J; International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004 Jan 22;350(4):351-60. link to original article PubMed

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

References

1. Scagliotti GV, Parikh P, von Pawel J, Biesma B, Vansteenkiste J, Manegold C, Serwatowski P, Gatzemeier U, Digumarti R, Zukin M, Lee JS, Mellemgaard A, Park K, Patil S, Rolski J, Goksel T, de Marinis F, Simms L, Sugarman KP, Gandara D. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008 Jul 20;26(21):3543-51. Epub 2008 May 27. 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

21-day cycles x 4 cycles

References

1. Scagliotti GV, Parikh P, von Pawel J, Biesma B, Vansteenkiste J, Manegold C, Serwatowski P, Gatzemeier U, Digumarti R, Zukin M, Lee JS, Mellemgaard A, Park K, Patil S, Rolski J, Goksel T, de Marinis F, Simms L, Sugarman KP, Gandara D. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008 Jul 20;26(21):3543-51. Epub 2008 May 27. link to original article contains protocol; note: reference was not for adjuvant therapy; patients in this study were stage IIIB or IV PubMed

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

References

1. Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J; International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004 Jan 22;350(4):351-60. link to original article PubMed

Cisplatin (Platinol) & Vinorelbine (Navelbine)

Regimen #1, Winton, et al. 2005

• 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

Regimen #2, Hotta, et al. 2001

• 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

Regimen #3, Arriagada, et al. 2004 & Douillard, et al. 2006

• 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

References

1. Hotta K, Sekine I, Tamura T, Sawada M, Watanabe H, Kusaba H, Akiyama Y, Inoue A, Shimoyama T, Nokihara H, Ueda Y, Yamamoto N, Kunitoh H, Ohe Y, Kodama T, Saijo N. A phase I/II study of cisplatin and vinorelbine chemotherapy in patients with advanced non-small cell lung cancer. Jpn J Clin Oncol. 2001 Dec;31(12):596-600. link to original article contains protocol PubMed
2. Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J; International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004 Jan 22;350(4):351-60. link to original article PubMed content property of HemOnc.org
3. Winton T, Livingston R, Johnson D, Rigas J, Johnston M, Butts C, Cormier Y, Goss G, Inculet R, Vallieres E, Fry W, Bethune D, Ayoub J, Ding K, Seymour L, Graham B, Tsao MS, Gandara D, Kesler K, Demmy T, Shepherd F; National Cancer Institute of Canada Clinical Trials Group; National Cancer Institute of the United States Intergroup JBR.10 Trial Investigators. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005 Jun 23;352(25):2589-97. link to original article PubMed
4. Douillard JY, Rosell R, De Lena M, Carpagnano F, Ramlau R, Gonzáles-Larriba JL, Grodzki T, Pereira JR, Le Groumellec A, Lorusso V, Clary C, Torres AJ, Dahabreh J, Souquet PJ, Astudillo J, Fournel P, Artal-Cortes A, Jassem J, Koubkova L, His P, Riggi M, Hurteloup P. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol. 2006 Sep;7(9):719-27. link to original article PubMed

Chemotherapy & radiation therapy

Carboplatin (Paraplatin), Paclitaxel (Taxol), concurrent RT

Regimen

Note: This regimen is listed by the NCCN, Non-Small Cell Lung Cancer version 2.2012, but this differs from the Belani, et al. 2005 reference, in which additional consolidation chemotherapy is given after completion of concurrent chemotherapy & radiation therapy. That regimen is detailed here.

• 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

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

Carboplatin (Paraplatin), Paclitaxel (Taxol), concurrent RT -> 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

Carboplatin (Paraplatin), Paclitaxel (Taxol), sequential RT

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

Cisplatin (Platinol), Etoposide (Vepesid), concurrent RT

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

Cisplatin (Platinol), Etoposide (Vepesid), concurrent RT -> consolidation chemo

Regimen

Note: The NCCN, Non-Small Cell Lung Cancer version 2.2012, describes "two extra cycles" of chemotherapy being given after completion of concurrent RT, but no primary reference can be found for this. It is unclear what the length of each cycle is supposed to be.

• 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

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--see note above PubMed

Cisplatin (Platinol), Vinblastine (Velban), concurrent RT

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

References

1. Curran WJ Jr, Paulus R, Langer CJ, Komaki R, Lee JS, Hauser S, Movsas B, Wasserman T, Rosenthal SA, Gore E, Machtay M, Sause W, Cox JD. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011 Oct 5;103(19):1452-60. Epub 2011 Sep 8. link to original article PubMed

Cisplatin (Platinol), Vinblastine (Velban), sequential RT

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

References

1. Curran WJ Jr, Paulus R, Langer CJ, Komaki R, Lee JS, Hauser S, Movsas B, Wasserman T, Rosenthal SA, Gore E, Machtay M, Sause W, Cox JD. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011 Oct 5;103(19):1452-60. Epub 2011 Sep 8. link to original article PubMed

Advanced or metastatic disease

Carboplatin (Paraplatin) & Docetaxel (Taxotere)

Regimen

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

21-day cycles

References

1. Fossella F, Pereira JR, von Pawel J, Pluzanska A, Gorbounova V, Kaukel E, Mattson KV, Ramlau R, Szczesna A, Fidias P, Millward M, Belani CP. Randomized, multinational, phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for advanced non-small-cell lung cancer: the TAX 326 study group. J Clin Oncol. 2003 Aug 15;21(16):3016-24. Epub 2003 Jul 1. link to original article contains protocol PubMed

Carboplatin (Paraplatin) & Gemcitabine (Gemzar)

Regimen

• Carboplatin (Paraplatin) AUC 5 IV day 1
• Gemcitabine (Gemzar) 1000-1250 mg/m2 IV days 1 & 8

21-day cycles

References

1. Sederholm C, Hillerdal G, Lamberg K, Kölbeck K, Dufmats M, Westberg R, Gawande SR. Phase III trial of gemcitabine plus carboplatin versus single-agent gemcitabine in the treatment of locally advanced or metastatic non-small-cell lung cancer: the Swedish Lung Cancer Study Group. J Clin Oncol. 2005 Nov 20;23(33):8380-8. link to original article contains protocol PubMed
2. Grønberg BH, Bremnes RM, Fløtten O, Amundsen T, Brunsvig PF, Hjelde HH, Kaasa S, von Plessen C, Stornes F, Tollåli T, Wammer F, Aasebø U, Sundstrøm S. Phase III study by the Norwegian lung cancer study group: pemetrexed plus carboplatin compared with gemcitabine plus carboplatin as first-line chemotherapy in advanced non-small-cell lung cancer. J Clin Oncol. 2009 Jul 1;27(19):3217-24. Epub 2009 May 11. link to original article contains protocol PubMed

Carboplatin (Paraplatin) & Paclitaxel (Taxol)

Regimen #1, Schiller, et al. 2002 & Socinski, et al. 2012

• 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

Regimen #2, Lynch, et al. 2012

• Carboplatin (Paraplatin) AUC 6 IV day 1
• Paclitaxel (Taxol) 175 mg/m2 IV on day 1

21-day cycles x up to 6 cycles

Supportive medications:

• Corticosteroids could be used as premedication for paclitaxel infusion.

Regimen #3, Quoix, et al. 2011 - weekly paclitaxel

Study involved only patients 70-89 years old

• Carboplatin (Paraplatin) AUC 6 IV on day 1
• Paclitaxel (Taxol) 90 mg/m2 IV on days 1, 8, 15

28-day cycles x up to 4 cycles

Supportive medications:

• Growth factor support was not recommended as primary prophylaxis during cycle 1, but could be used if the patient develops grade 3-4 neutropenia

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
2. Quoix E, Zalcman G, Oster JP, Westeel V, Pichon E, Lavolé A, Dauba J, Debieuvre D, Souquet PJ, Bigay-Game L, Dansin E, Poudenx M, Molinier O, Vaylet F, Moro-Sibilot D, Herman D, Bennouna J, Tredaniel J, Ducoloné A, Lebitasy MP, Baudrin L, Laporte S, Milleron B; Intergroupe Francophone de Cancérologie Thoracique. Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. Lancet. 2011 Sep 17;378(9796):1079-88. Epub 2011 Aug 8. link to original article contains verified protocol PubMed
3. Lynch TJ, Bondarenko I, Luft A, Serwatowski P, Barlesi F, Chacko R, Sebastian M, Neal J, Lu H, Cuillerot JM, Reck M. Ipilimumab in combination with paclitaxel and carboplatin as first-line treatment in stage IIIB/IV non-small-cell lung cancer: results from a randomized, double-blind, multicenter phase II study. J Clin Oncol. 2012 Jun 10;30(17):2046-54. Epub 2012 Apr 30. link to original article contains verified protocol PubMed
4. Socinski MA, Bondarenko I, Karaseva NA, Makhson AM, Vynnychenko I, Okamoto I, Hon JK, Hirsh V, Bhar P, Zhang H, Iglesias JL, Renschler MF. Weekly nab-paclitaxel in combination with carboplatin versus solvent-based paclitaxel plus carboplatin as first-line therapy in patients with advanced non-small-cell lung cancer: final results of a phase III trial. J Clin Oncol. 2012 Jun 10;30(17):2055-62. Epub 2012 Apr 30. link to original article contains verified protocol PubMed

Carboplatin (Paraplatin) & nab-Paclitaxel (Abraxane)

Regimen

• Carboplatin (Paraplatin) AUC 6 mg/mL/min (per Calvert formula) IV day 1, given second, after nab-Paclitaxel
• Paclitaxel, nanoparticle albumin-bound (Abraxane) 100 mg/m2 IV over 30 minutes on days 1, 8, 15, given first

21-day cycles x 6 cycles; treatment could continue at physician's discretion if there was no progressive disease or unacceptable toxicity

References

1. Socinski MA, Bondarenko I, Karaseva NA, Makhson AM, Vynnychenko I, Okamoto I, Hon JK, Hirsh V, Bhar P, Zhang H, Iglesias JL, Renschler MF. Weekly nab-paclitaxel in combination with carboplatin versus solvent-based paclitaxel plus carboplatin as first-line therapy in patients with advanced non-small-cell lung cancer: final results of a phase III trial. J Clin Oncol. 2012 Jun 10;30(17):2055-62. Epub 2012 Apr 30. link to original article contains verified 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

References

1. Johnson DH, Fehrenbacher L, Novotny WF, Herbst RS, Nemunaitis JJ, Jablons DM, Langer CJ, DeVore RF 3rd, Gaudreault J, Damico LA, Holmgren E, Kabbinavar F. Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol. 2004 Jun 1;22(11):2184-91. link to original article PubMed
2. Ramalingam SS, Dahlberg SE, Langer CJ, Gray R, Belani CP, Brahmer JR, Sandler AB, Schiller JH, Johnson DH; Eastern Cooperative Oncology Group. Outcomes for elderly, advanced-stage non small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: analysis of Eastern Cooperative Oncology Group Trial 4599. J Clin Oncol. 2008 Jan 1;26(1):60-5. link to original article PubMed

Carboplatin (Paraplatin), Paclitaxel (Taxol), Ipilimumab (Yervoy)

Regimen - phased ipilimumab

Induction phase:

• Carboplatin (Paraplatin) AUC 6 IV day 1
• Paclitaxel (Taxol) 175 mg/m2 IV on day 1
• Ipilimumab (Yervoy) 10 mg/kg IV on day 1 of cycles 3-6

Supportive medications:

• Corticosteroids could be used as premedication for paclitaxel infusion or for toxicity management.

21-day cycles x up to 6 cycles

Patients without progressive disease continued to receive maintenance therapy:

• Ipilimumab (Yervoy) 10 mg/kg IV on day 1

12-week cycles, given until progression of disease or unacceptable toxicity

References

1. Lynch TJ, Bondarenko I, Luft A, Serwatowski P, Barlesi F, Chacko R, Sebastian M, Neal J, Lu H, Cuillerot JM, Reck M. Ipilimumab in combination with paclitaxel and carboplatin as first-line treatment in stage IIIB/IV non-small-cell lung cancer: results from a randomized, double-blind, multicenter phase II study. J Clin Oncol. 2012 Jun 10;30(17):2046-54. Epub 2012 Apr 30. link to original article contains verified protocol PubMed

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

• Example orders for Carboplatin (Paraplatin) and Pemetrexed (Alimta) in non-small cell lung cancer

References

1. Grønberg BH, Bremnes RM, Fløtten O, Amundsen T, Brunsvig PF, Hjelde HH, Kaasa S, von Plessen C, Stornes F, Tollåli T, Wammer F, Aasebø U, Sundstrøm S. Phase III study by the Norwegian lung cancer study group: pemetrexed plus carboplatin compared with gemcitabine plus carboplatin as first-line chemotherapy in advanced non-small-cell lung cancer. J Clin Oncol. 2009 Jul 1;27(19):3217-24. Epub 2009 May 11. 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) & 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

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) & 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

References

1. Scagliotti GV, Parikh P, von Pawel J, Biesma B, Vansteenkiste J, Manegold C, Serwatowski P, Gatzemeier U, Digumarti R, Zukin M, Lee JS, Mellemgaard A, Park K, Patil S, Rolski J, Goksel T, de Marinis F, Simms L, Sugarman KP, Gandara D. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008 Jul 20;26(21):3543-51. Epub 2008 May 27. link to original article contains protocol PubMed

Crizotinib (Xalkori)

Regimen

• Crizotinib (Xalkori) 250 mg PO BID on days 1-28

28-day cycles, given until progression of disease or unacceptable toxicity

References

1. Kwak EL, Bang YJ, Camidge DR, Shaw AT, Solomon B, Maki RG, Ou SH, Dezube BJ, Jänne PA, Costa DB, Varella-Garcia M, Kim WH, Lynch TJ, Fidias P, Stubbs H, Engelman JA, Sequist LV, Tan W, Gandhi L, Mino-Kenudson M, Wei GC, Shreeve SM, Ratain MJ, Settleman J, Christensen JG, Haber DA, Wilner K, Salgia R, Shapiro GI, Clark JW, Iafrate AJ. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med. 2010 Oct 28;363(18):1693-703. link to original article contains verified protocol PubMed

Docetaxel (Taxotere)

Regimen

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

21-day cycles

• Example orders for Docetaxel (Taxotere) in non-small cell lung cancer

Alternate schedule:

• Docetaxel (Taxotere) 35 mg/m2 IV days 1, 8, 15

28-day cycles

References

1. Hanna N, Shepherd FA, Fossella FV, Pereira JR, De Marinis F, von Pawel J, Gatzemeier U, Tsao TC, Pless M, Muller T, Lim HL, Desch C, Szondy K, Gervais R, Shaharyar, Manegold C, Paul S, Paoletti P, Einhorn L, Bunn PA Jr. Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol. 2004 May 1;22(9):1589-97. link to original article contains protocol PubMed
2. Chen YM, Shih JF, Perng RP, Tsai CM, Whang-Peng J. A randomized trial of different docetaxel schedules in non-small cell lung cancer patients who failed previous platinum-based chemotherapy. Chest. 2006 Apr;129(4):1031-8. link to original article contains protocol PubMed

Erlotinib (Tarceva)

• Erlotinib (Tarceva) 150 mg PO daily

References

1. Lilenbaum R, Axelrod R, Thomas S, Dowlati A, Seigel L, Albert D, Witt K, Botkin D. Randomized phase II trial of erlotinib or standard chemotherapy in patients with advanced non-small-cell lung cancer and a performance status of 2. J Clin Oncol. 2008 Feb 20;26(6):863-9. link to original article contains protocol PubMed
2. Shepherd FA, Rodrigues Pereira J, Ciuleanu T, Tan EH, Hirsh V, Thongprasert S, Campos D, Maoleekoonpiroj S, Smylie M, Martins R, van Kooten M, Dediu M, Findlay B, Tu D, Johnston D, Bezjak A, Clark G, Santabárbara P, Seymour L; National Cancer Institute of Canada Clinical Trials Group. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005 Jul 14;353(2):123-32. link to original article contains protocol PubMed

Gefitinib (Iressa)

• Gefitinib (Iressa) 250 mg PO daily

References

1. Kim ES, Hirsh V, Mok T, Socinski MA, Gervais R, Wu YL, Li LY, Watkins CL, Sellers MV, Lowe ES, Sun Y, Liao ML, Osterlind K, Reck M, Armour AA, Shepherd FA, Lippman SM, Douillard JY. Gefitinib versus docetaxel in previously treated non-small-cell lung cancer (INTEREST): a randomised phase III trial. Lancet. 2008 Nov 22;372(9652):1809-18. link to original article contains protocol PubMed

Gemcitabine (Gemzar)

Regimen #1, Quoix, et al. 2011

Study involved only patients 70-89 years old

• Gemcitabine (Gemzar) 1150 mg/m2 IV on days 1 & 8

21-day cycles x up to 5 cycles

Supportive medications:

• Growth factor support was not recommended as primary prophylaxis during cycle 1, but could be used if the patient develops grade 3-4 neutropenia

Regimen #2, Gridelli, et al. 2003

Study involved only patients at least 70 years old

• Gemcitabine (Gemzar) 1200 mg/m2 IV on days 1 & 8

21-day cycles x up to 6 cycles

Supportive medications:

• "Antiemetic agents and other supportive treatments were provided at the discretion of the treating physician."

References

1. Gridelli C, Perrone F, Gallo C, Cigolari S, Rossi A, Piantedosi F, Barbera S, Ferraù F, Piazza E, Rosetti F, Clerici M, Bertetto O, Robbiati SF, Frontini L, Sacco C, Castiglione F, Favaretto A, Novello S, Migliorino MR, Gasparini G, Galetta D, Iaffaioli RV, Gebbia V; MILES Investigators. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst. 2003 Mar 5;95(5):362-72. link to original article contains verified protocol PubMed
2. Quoix E, Zalcman G, Oster JP, Westeel V, Pichon E, Lavolé A, Dauba J, Debieuvre D, Souquet PJ, Bigay-Game L, Dansin E, Poudenx M, Molinier O, Vaylet F, Moro-Sibilot D, Herman D, Bennouna J, Tredaniel J, Ducoloné A, Lebitasy MP, Baudrin L, Laporte S, Milleron B; Intergroupe Francophone de Cancérologie Thoracique. Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. Lancet. 2011 Sep 17;378(9796):1079-88. Epub 2011 Aug 8. link to original article contains verified protocol PubMed

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

• Example orders for Pemetrexed (Alimta) in non-small cell lung cancer

References

1. Hanna N, Shepherd FA, Fossella FV, Pereira JR, De Marinis F, von Pawel J, Gatzemeier U, Tsao TC, Pless M, Muller T, Lim HL, Desch C, Szondy K, Gervais R, Shaharyar, Manegold C, Paul S, Paoletti P, Einhorn L, Bunn PA Jr. Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol. 2004 May 1;22(9):1589-97. link to original article contains protocol PubMed

Vinorelbine (Navelbine)

Regimen #1, Quoix, et al. 2011

Study involved only patients 70-89 years old

• Vinorelbine (Navelbine) 25 mg/m2 IV on days 1 & 8

21-day cycles x up to 5 cycles

Supportive medications:

• Growth factor support was not recommended as primary prophylaxis during cycle 1, but could be used if the patient develops grade 3-4 neutropenia

Regimen #2, Elderly Lung Cancer Vinorelbine Italian Study Group, 1999 & Gridelli, et al. 2003

Study involved only patients at least 70 years old

• Vinorelbine (Navelbine) 30 mg/m2 IV on days 1 & 8

21-day cycles x up to 6 cycles

Supportive medications (varies depending on reference):

• Elderly Lung Cancer Vinorelbine Italian Study Group, 1999: Metoclopramide (Reglan) 20 mg IV bolus prior to vinorelbine
• Gridelli, et al. 2003: "Antiemetic agents and other supportive treatments were provided at the discretion of the treating physician."

References

1. The Elderly Lung Cancer Vinorelbine Italian Study Group. Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small-cell lung cancer. J Natl Cancer Inst. 1999 Jan 6;91(1):66-72. link to original article contains verified protocol PubMed
2. Gridelli C, Perrone F, Gallo C, Cigolari S, Rossi A, Piantedosi F, Barbera S, Ferraù F, Piazza E, Rosetti F, Clerici M, Bertetto O, Robbiati SF, Frontini L, Sacco C, Castiglione F, Favaretto A, Novello S, Migliorino MR, Gasparini G, Galetta D, Iaffaioli RV, Gebbia V; MILES Investigators. Chemotherapy for elderly patients with advanced non-small-cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst. 2003 Mar 5;95(5):362-72. link to original article contains verified protocol PubMed
3. Quoix E, Zalcman G, Oster JP, Westeel V, Pichon E, Lavolé A, Dauba J, Debieuvre D, Souquet PJ, Bigay-Game L, Dansin E, Poudenx M, Molinier O, Vaylet F, Moro-Sibilot D, Herman D, Bennouna J, Tredaniel J, Ducoloné A, Lebitasy MP, Baudrin L, Laporte S, Milleron B; Intergroupe Francophone de Cancérologie Thoracique. Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. Lancet. 2011 Sep 17;378(9796):1079-88. Epub 2011 Aug 8. link to original article contains verified protocol PubMed