chemotherapy in lung cancer

Last reviewed 01/2018

Chemotherapy in non-small cell lung cancer:

  • generally unrewarding - few patients show a good response and many suffer toxic side-effects
  • drug combinations such as mitomycin, ifosfamide and cisplatin have recently shown responses in more than half of patients who presented with limited disease (disease confined to one hemithorax)
  • meta-analysis of seven studies comparing chemotherapy with the best supportive care has revealed a significantly greater survival and quality of life during the first six months after chemotherapy

Chemotherapy in small-cell lung cancer:

  • main form of therapy in small-cell lung cancer
  • six courses of combination chemotherapy are adequate and optimal for most patients
  • 80-90% response rates after combination chemotherapy but the long-term prognosis remains poor (8% 2 year survival if presents with limited disease; 2% 2 year survival if presents with extensive disease)
  • chemotherapeutic tumour resolution improves symptoms such as dyspnoea, pain, anorexia, breathlessness and haemoptysis in 2/3 of patients
  • radiotherapy to the mediastinum and primary tumour site after a good, ideally complete, response to chemotherapy leads to a further increased chance of long-term survival
  • NICE state that (1):
    • oral topotecan is recommended as an option only for people with relapsed small-cell lung cancer for whom:
      • re-treatment with the first-line regimen is not considered appropriate and
      • the combination of cyclophosphamide, doxorubicin and vincristine (CAV) is contraindicated
    • intravenous topotecan is not recommended for people with relapsed small-cell lung cancer

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