Lung cancer NSCLC treatment

Background Non-small Cell Lung Cancer (NSCLC) Treatment... 

There are four major histologic types of lung cancer that are divided into two classes based on response to treatment and prognosis small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). However, it is important to note that certain other rare malignancies can be seen as well as mixed-type carcinomas. The four major types of lung cancer are outlined in Table 87-1. 

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). 

Radiation therapy is the treatment of choice for chemotherapy-resistant tumors such as non-small cell lung cancer (NSCLC) or in chemotherapy-refractory patients with SVCS. Between 70% and 90% of patients will experience relief of symptoms. Radiation therapy also may be combined with chemotherapy for chemotherapy-sensitive tumors such as SCLC and lymphoma. In the rare emergency situations of airway obstruction or elevated intracranial pressure, empirical radiotherapy prior to tissue diagnosis should be used. In most patients, symptoms resolve within 1 to 3 weeks. 

Early clinical studies clearly demonstrated that cisplatin could be administered safely and concurrently with radiation therapy (73-75). Early clinical trials that demonstrated the promise of the combination of cisplatin and radiation therapy included the treatment of brain tumors (76,77), head and neck tumors (78), malignant melanoma (79), and bladder cancer (80). Early clinical trial integrating carboplatin administration with radiation therapy was carried out in patients with locally advanced nonsmall cell lung cancer (NSCLC) (81). A hypothesis put forth by Coughlin and colleagues (81) was that the best clinical outcomes would be achieved with the combination of cisplatin and radiation therapy in tumors that were responsive to cisplatin. 

Graham MV, Purdy JA, Emami B, et al. Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 1999 45(2) 323-329. 

Some of the clinical results are summarized in Table 8. More detailed information on lung cancers [nonsmall cell lung cancer (NSCLC)] is given in Table 9, in particular, about patient selection and treatment conditions [48]. The possibility of hypofractionation has been investigated especially for lung and liver cancers with no increase in toxicity. 

VFL is a novel vinca alkaloid obtained by semisynthesis using super-acidic chemistry to introduce two fluorine atoms selectively at the 20 position of VRLB. The preclinical evaluations of the new derivative VFL have already suggested that certain in vitro assays, in addition to in vivo experiments, could be proposed to select more rationally newer generation Vincas. Moreover, recent studies have demonstrated that certain newly identifled properties, such as antiangiogenic activities, could enlarge the therapeutic usage of natural and semisynthetic vinca alkaloids. VFL is presently in phase III experimentation for treatment of bladder cancer and nonsmall-cell lung cancer (NSCLC) [72]. 

Dansin E et al. Safety of bevacizumab-based therapy as first-line treatment of patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC) MO19390 (SAiL). Journal of Clinical Oncology (Meeting Abstracts) 2008 26 8085. 

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