Non-Small Cell Lung Cancer - Radiation Treatments

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• Docetaxel (Taxotere). Docetaxel is the drug of choice at this time for cancers that do not respond to initial chemotherapy. Studies have reported that it achieves longer survival times than supportive care alone. It is usually given every 21 days. This regimen causes more side effects than pemetrexed, the newer second-line drug. Weekly doses of docetaxel are effective and less toxic than the 3-week schedule. It is not clear if the weekly schedule achieves survival rates comparable to those of pemetrexed, however.
• Pemetrexed (Alimta). Pemetrexed, a first-line treatment of nonsquamous non-small cell lung cancer in combination with cisplatin, is also approved as a single second-line treatment of the same type of cancer. Some research suggests that it is as effective as docetaxel. It is less toxic than docetaxel when docetaxel is given every 21 days, but not when it is given weekly.
• Erlotinib (Tarceva), Gefitinib (Iressa) and Other Tyrosine Kinase Inhibitors. Research is focusing on drugs that block small molecules involved with the growth of blood vessels that feed the tumor (a process called angiogenesis). Compounds called growth factors, which may be important in cancer cell production, control the growth of these new blood vessels. Medications that literally turn off these growth factors or their receptors may be able to cut off cancer's lifeblood. Gefitinib and erlotinib are angiogenesis inhibitors.
  • Erlotinib (Tarceva) was approved as a single agent second-line therapy in November 2004. Erlotinib is taken by mouth and has very low risk of side effects (rash and diarrhea are common).
  • Gefitinib (Iressa) was approved in 2003 as a second-line therapy for non-small cell lung cancer. It has shown promise in patients with EGFR gene involvement.

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Combinations of Chemotherapy with Surgery, Radiation Therapy, or Both

Particularly for more aggressive or advanced cancers, different combinations of surgery, chemotherapy, and radiation therapy may be tried. These include:

• Chemotherapy Following Surgery (Adjuvant Chemotherapy). Evidence is now supporting the use of platinum-based chemotherapy after surgery in some patients with lung cancers. Not all studies confirm survival benefits, however, and trials are ongoing.
• Chemotherapy before Surgery (Induction or neoadjuvant Chemotherapy). Induction chemotherapy may be used to shrink tumors before surgery. Studies have been mixed as to whether there are any survival benefits in patients with advanced lung cancer.
• Combined and Multi-Modal Therapy. In more advanced cancers, investigators are researching very intensive treatments that use two or more combinations of chemotherapy, radiation, and surgery. For example, radiation plus chemotherapy may be helpful in patients whose tumors are surgically removable. Such approaches are very toxic but appear to improve survival in selected patients.