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
- 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
References
- 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
- 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
- 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
- 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
- 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
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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
References
- 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
- 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
- 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
- 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
- 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, Kwak, et al. 2010 & Shaw, et al. 2013
- Crizotinib (Xalkori) 250 mg PO BID on days 1 to 28
28-day cycles, given until progression of disease or unacceptable toxicity. Shaw, et al. 2013 used 21-day cycles, and crizotinib was similarly given 250 mg PO BID on all days.
References
- 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
- Shaw AT, Yeap BY, Solomon BJ, Riely GJ, Gainor J, Engelman JA, Shapiro GI, Costa DB, Ou SH, Butaney M, Salgia R, Maki RG, Varella-Garcia M, Doebele RC, Bang YJ, Kulig K, Selaru P, Tang Y, Wilner KD, Kwak EL, Clark JW, Iafrate AJ, Camidge DR. Effect of crizotinib on overall survival in patients with advanced non-small-cell lung cancer harbouring ALK gene rearrangement: a retrospective analysis. Lancet Oncol. 2011 Oct;12(11):1004-12. doi: 10.1016/S1470-2045(11)70232-7. Epub 2011 Sep 18. link to original article PubMed
- Shaw AT, et al. Crizotinib versus Chemotherapy in Advanced ALK-Positive Lung Cancer. N Engl J Med. Epub 2013 Jun 1. link to original article
Docetaxel (Taxotere)
Regimen
- Docetaxel (Taxotere) 75 mg/m2 IV day 1
21-day cycles
Alternate schedule:
- Docetaxel (Taxotere) 35 mg/m2 IV days 1, 8, 15
28-day cycles
References
- 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
- 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
- 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
- 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
- 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
- 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
- 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 #1, Hanna, et al. 2004
- 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
Regimen #2, Paz-Ares, et al. 2012 - maintenance therapy, PARAMOUNT trial
Patients in this study had received 4 cycles of induction therapy with Cisplatin (Platinol) & Pemetrexed (Alimta). Maintenance therapy started 21–42 days after cycle 4 day 1 of induction chemotherapy.
- Pemetrexed (Alimta) 500 mg/m2 IV day 1
21-day cycles, given until progression of disease, unacceptable toxicity, or physician/patient choice
Supportive medications:
- Folic acid, vitamin B12, prophylactic dexamethasone
- "Investigators followed current American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) guidelines for use of colony-stimulating factors and erythropoiesis-stimulating agents."
References
- 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
- Paz-Ares L, de Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann AH, Visseren-Grul C, Gridelli C. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol. 2012 Mar;13(3):247-55. doi: 10.1016/S1470-2045(12)70063-3. Epub 2012 Feb 16. link to original article contains verified protocol PubMed
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."
Regimen #3, Jassem, et al. 2001
- Vinorelbine (Navelbine) 30 mg/m2 IV over 5 to 10 minutes once per week
treatment given once per week
Supportive medications:
- Patients who had either grade 4 neutropenia lasting at least 5 days or both fever and grade 3 or 4 neutropenia could receive G-CSF (dose/schedule/duration not specified)
- Metoclopramide (Reglan) (dose/schedule/route not specified) used first for nausea
- Nausea despite metoclopramide was treated with a 5-HT3 antagonist such as ondansetron (Zofran) or granisetron (Kytril) (dose/schedule/route not specified) prn nausea
References
- 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
- Jassem J, Ramlau R, Karnicka-Młodkowska H, Krawczyk K, Krzakowski M, Zatloukal P, Lemarié E, Hartmann W, Novakova L, O'Brien M, Depierr A. A multicenter randomized phase II study of oral vs. intravenous vinorelbine in advanced non-small-cell lung cancer patients. Ann Oncol. 2001 Oct;12(10):1375-81. link to original article contains verified protocol PubMed
- 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
- 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