Advanced non-small cell lung cancer

Abstract

The treatment of advanced non-small cell lung cancer requires histologic proof of diagnosis, careful staging, and assessment of each patient's performance status and comorbidities. For patients with stage IIIB (pleural effusion) and stage IV disease who have a Cancer and Leukemia Group B performance status (PS) of 0 to 1, appropriate management consists of combination chemotherapy with a platinum (either cisplatin or carboplatin) combined with paclitaxel, gemcitabine, vinorelbine, docetaxel, or CPT-11. Dosages and schedules previously established by large phase II or phase III studies should be followed. Variations in the toxicity patterns, schedules of administration, and economic considerations should guide the selection of the specific regimen. For patients who maintain a good performance status after first-line chemotherapy, second-line treatment may be considered. Current evidence supports the use of docetaxel as second-line treatment if the patient has not previously received this drug. Gemcitabine and paclitaxel may also have activity in this setting. Vinorelbine, ifosfamide, and CPT-11 appear to be inactive as second-line therapy for patients who have previously received platinum-based chemotherapy. For patients with a PS of 2, single-agent chemotherapy with vinorelbine, gemcitabine, or a combination of the two should be considered. Patients with poor performance status should be treated with supportive measures designed to relieve pain and acute complications because any tumor-directed therapy has limited benefit. Special situations exist in which curative therapy for metastatic disease is a possibility. Patients who present with solitary sites of metastatic disease, particularly after a long disease-free interval and in the CNS may undergo definitive surgery or radiotherapy with curative intent. Some have also reported favorable outcomes for patients with solitary adrenal or bone metastases as well. Surgical treatment or definitive radiotherapy should not be employed unless a thorough restaging evaluation is performed that includes computed tomography scan of the chest and abdomen through adrenals, brain magnetic resonance imaging, and positron emission tomography scan. A plethora of new agents targeting angiogenesis, tumor invasiveness, the hypoxic environment of tumors, and the cell cycle are currently in development.

Metastasis to the occipitocervical junction: A case report and review of the literature

“…[4] Of these comorbidities, bone pain is the most common, seen in 80% of patients with skeletal NSCLC metastases. [612] Other SREs such as fractures and hypercalcemia owe their pathophysiology primarily to the tumor-induced increase of osteoclast differentiation relative to osteoblasts. [811] Nevertheless, despite the prevalence of skeletal metastases—with the spine, ribs, and pelvis being the most common—encroachment upon the occipital condyle and atlas is exceedingly rare.…”

Treatment options for brain metastases in patients with non-small cell lung cancer

“…• Studies have demonstrated clearly that chemotherapy has a benefit in survival rate and quality of life for patients with advanced NSCLC [16]. …”

Follow-up of local (stage I and stage II) non-small-cell lung cancer after surgical resection

“…The choice of a specific regimen is governed by other medical conditions, convenience, and economics. An overview of management for advanced NSCLC was recently published by Edelman and Khanwani [37]. Occasionally, a patient may present with a…”