Non-Small Cell Lung Cancer - Radiation Treatments

Chemotherapy Treatments

Chemotherapy is the use of drugs given by mouth or injection to destroy cancer cells that may have spread beyond the tumor. Until recently, there has been some doubt about the effectiveness of chemotherapy for lung cancer. A major analysis of 52 trials supported its use, particularly with platinum-based regimens, and with the combination of supportive care.

• Chemotherapy in early stages: Chemotherapy is proving to be beneficial in many patients as an additional (adjuvant) treatment with surgery or radiation.
• Chemotherapy in advanced disease: Chemotherapy may be used as first-line treatment in patients with inoperable or metastasized lung cancer. It is typically used in late stages to reduce symptoms and, in some cases, extend survival.
• Since 2006, the combination of bevacizumab (Avastin) and platinum-based chemotherapy is also a first-line treatment choice for patients with advanced, non-squamous cancer. Bevacizumab is a monoclonal antibody which inhibits growth of new blood vessels. Studies show that it increases survival, but unfortunately only for less than 2 months. Bleeding, high blood pressure, and kidney damage are reported side effects.

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Chemotherapy Drugs and Regimens

Most chemotherapy regimens use platinum compounds, either cisplatin (Platinol) or carboplatin (Paraplatin). The preferred regimen uses two drugs -- one of which is a platinum-based drug. Combinations may include paclitaxel (Taxol) and carboplatin or cisplatin. This regimen can also include gemcitabine, docetaxel, or vinblastine (vindesine or vinorelbine). There do not seem to be any significant differences in effectiveness among these regimens. The gemcitabine and vinorelbine combination might be a good option for patients who cannot tolerate platinum compounds.

More attention is being given to agents called biologic response modifiers, such as the EGFR gene inhibitor gefitinib (Iressa). Gefitinib (Iressa), a second-line therapy for non-small cell lung cancer, is now available only for a limited group of patients. Use of gefitinib (Iressa) for early stages of lung cancer when gene testing suggests the tumor may respond is showing some promise.