Lung cancer advanced/metastatic disease

The first step in treatment of NSCLC involves confirmation of the clinical stage and determination of resectability of the tumor. This decision always should be made by a thoracic surgeon who routinely performs lung cancer surgery. Treatment options depend on the advancement of disease (i.e., local, locally advanced, or metastatic). 

Many lung cancers go undetected until they are advanced because individuals who have a long history of cigarette smoking are unlikely to notice the early symptoms of cough or dyspnea. It is often symptoms associated with large tumors or metastatic disease that prompt medical attention. 

Pemetrexed is a folic-acid antagonist that disrupts folate-dependent metabolic processes essential for cell replication. It is indicated in combination with cisplatin for the treatment of malignant pleural mesothelioma in patients whose disease is unresectable or who are otherwise not candidates for curative surgery and as a single agent for the treatment of locally advanced or metastatic non-small-cell lung cancer after prior chemotherapy. 

Bone metastases are common in many advanced cancers and are a clinically relevant source of skeletal morbidity. Nearly 30% of all malignant tumors induce bone metastases Qemal et al. 2004 Thomas et al. 1996). Most often, the spinal column (80%) and the femur (40%) are affected. In particular, breast, lung and bronchus, prostate and kidney cancer types have a high rate of inducing bone metastases. Prostate cancer in males and breast cancer in females are the most common cancer types (Jemal et al. 2004). In the US 33% of the estimated new cases of cancer in males are induced by prostate cancer (230,110 cases of new prostate cancer per year). Of the new cases in females, 32% are induced by breast cancer (215,990 cases of new breast cancer per year) (Jemal et al. 2004 Thomas et al. 1996). Of all patients with breast and prostate cancer, 60%-80% develop bone metastases. Pain is the most frequent complication in metastatic bone disease. More than 80% of patients suffer from pain with a reduction of mobility and life quality therefore they have a high risk of concomitant complications. Therapy of bone metastases has three main goals ... 

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