Difference between revisions of "Non-small cell lung cancer"
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(Created page with "{{TOC limit|limit=3}} ==Adjuvant therapy== ===Cisplatin (Platinol) & Vinorelbine (Navelbine) #1=== ====Regimen==== *Cisplatin (Platinol) 50 mg/m2 IV on days 1 & 8 *[[Vinorel...") |
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| Line 88: | Line 88: | ||
==Chemotherapy & radiation therapy== | ==Chemotherapy & radiation therapy== | ||
| − | ===Cisplatin (Platinol) & Etoposide (Vepesid) | + | ===Concurrent RT with Cisplatin (Platinol) & Etoposide (Vepesid)=== |
====Regimen==== | ====Regimen==== | ||
*[[Cisplatin (Platinol)]] 50 mg/m2 IV on days 1, 8, 29, 36 | *[[Cisplatin (Platinol)]] 50 mg/m2 IV on days 1, 8, 29, 36 | ||
*[[Etoposide (Vepesid)]] 50 mg/m2 IV on days 1-5, 29-33 | *[[Etoposide (Vepesid)]] 50 mg/m2 IV on days 1-5, 29-33 | ||
| − | *Concurrent radiation therapy | + | *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==== | ====References==== | ||
| + | # 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. [http://jco.ascopubs.org/content/20/16/3454.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/12177106 PubMed] | ||
| − | ===Cisplatin (Platinol) & Vinblastine (Velban) | + | ===Concurrent RT with Cisplatin (Platinol) & Vinblastine (Velban)=== |
====Regimen==== | ====Regimen==== | ||
*[[Cisplatin (Platinol)]] 100 mg/m2 IV on days 1 & 29 | *[[Cisplatin (Platinol)]] 100 mg/m2 IV on days 1 & 29 | ||
| Line 108: | Line 111: | ||
====References==== | ====References==== | ||
| − | ===Carboplatin (Paraplatin) & Paclitaxel (Taxol) | + | ===Concurrent RT with Carboplatin (Paraplatin) & Paclitaxel (Taxol)=== |
====Regimen==== | ====Regimen==== | ||
| − | *[[Carboplatin (Paraplatin)]] AUC 2 IV over 30 minutes | + | *[[Carboplatin (Paraplatin)]] AUC 2 IV over 30 minutes days 1, 8, 15 (administered second) |
| − | *[[Paclitaxel (Taxol)]] 45 | + | *[[Paclitaxel (Taxol)]] 45 mg/m2 IV over 1 hour day 1, 8, 15 (administered first) |
| − | *Concurrent radiation therapy | + | *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 [[#Concurrent_RT_with_Carboplatin_.28Paraplatin.29_.26_Paclitaxel_.28Taxol.29.2C_then_consolidation_chemo|regimen is listed below]]. |
====References==== | ====References==== | ||
| + | # 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. [http://jco.ascopubs.org/content/23/25/5883.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/16087941 PubMed] | ||
| − | ===Cisplatin (Platinol) & Vinblastine (Velban) | + | ===Sequential RT with Cisplatin (Platinol) & Vinblastine (Velban)=== |
====Regimen==== | ====Regimen==== | ||
*[[Cisplatin (Platinol)]] 100 mg/m2 IV on days 1 & 29 | *[[Cisplatin (Platinol)]] 100 mg/m2 IV on days 1 & 29 | ||
| Line 126: | Line 132: | ||
'''5-week total course of chemotherapy''' | '''5-week total course of chemotherapy''' | ||
| − | ===Carboplatin (Paraplatin) & Paclitaxel (Taxol) | + | ===Sequential RT with Carboplatin (Paraplatin) & Paclitaxel (Taxol)=== |
====Regimen==== | ====Regimen==== | ||
| − | *[[Carboplatin (Paraplatin)]] AUC 6 IV day 1 | + | *[[Carboplatin (Paraplatin)]] AUC 6 IV over 30 minutes day 1 (administered second) |
| − | *[[Paclitaxel (Taxol)]] 200 mg/m2 IV over 3 hours day 1 | + | *[[Paclitaxel (Taxol)]] 200 mg/m2 IV over 3 hours day 1 (administered first) |
'''21-day cycles x 2 cycles''' | '''21-day cycles x 2 cycles''' | ||
| − | *Radiation therapy given after chemotherapy is complete | + | *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==== | ====References==== | ||
| + | # 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. [http://jco.ascopubs.org/content/23/25/5883.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/16087941 PubMed] | ||
| − | ===Cisplatin (Platinol) & Etoposide (Vepesid), | + | ===Concurrent RT with Cisplatin (Platinol) & Etoposide (Vepesid), then consolidation chemo=== |
====Regimen==== | ====Regimen==== | ||
*[[Cisplatin (Platinol)]] 50 mg/m2 IV on days 1, 8, 29, 36 | *[[Cisplatin (Platinol)]] 50 mg/m2 IV on days 1, 8, 29, 36 | ||
*[[Etoposide (Vepesid)]] 50 mg/m2 IV on days 1-5, 29-33 | *[[Etoposide (Vepesid)]] 50 mg/m2 IV on days 1-5, 29-33 | ||
| − | *Concurrent radiation therapy, | + | *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) |
| − | *[[Cisplatin (Platinol)]] 50 mg/m2 IV on days 1 | + | '''5-week initial course of chemotherapy & radiation, THEN''' |
| − | *[[Etoposide (Vepesid)]] 50 mg/m2 IV on days 1-5, | + | |
| + | *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==== | ||
| + | # 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. [http://jco.ascopubs.org/content/20/16/3454.long link to original article] '''contains protocol, but not for additional chemotherapy''' [http://www.ncbi.nlm.nih.gov/pubmed/12177106 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==== | ====References==== | ||
| + | # 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. [http://jco.ascopubs.org/content/23/25/5883.long link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/16087941 PubMed] | ||
| + | |||
==Advanced or metastatic disease== | ==Advanced or metastatic disease== | ||
Revision as of 23:39, 19 February 2012
Adjuvant therapy
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
References
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
References
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
References
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
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
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
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
References
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
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
References
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
- 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
References
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
- 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
- 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
- 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
- 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