From the Guidelines
Treatment options for malignant neoplasm of the lung should prioritize platinum-based chemotherapy, targeted therapies, and immunotherapies based on the patient's cancer histology, molecular testing results, disease stage, and performance status, with a focus on improving overall survival and quality of life. The selection of treatment for lung cancer depends on several factors including the type and stage of the cancer, as well as the patient's overall health and performance status.
- For early-stage non-small cell lung cancer (NSCLC), surgery is the primary treatment, including lobectomy, pneumonectomy, or wedge resection to remove the tumor and surrounding tissue 1.
- Radiation therapy is used either alone for early-stage patients who cannot undergo surgery or in combination with other treatments, typically delivered in daily fractions over 5-7 weeks.
- Chemotherapy regimens include platinum-based combinations such as cisplatin/carboplatin with pemetrexed, paclitaxel, or gemcitabine, usually administered in 4-6 cycles every 3 weeks, as recommended by recent guidelines 1.
- Targeted therapies are prescribed for patients with specific genetic mutations: osimertinib for EGFR mutations, alectinib or brigatinib for ALK rearrangements, and crizotinib for ROS1 mutations.
- Immunotherapy options include pembrolizumab, nivolumab, and atezolizumab, which activate the immune system against cancer cells and are often used for advanced disease, with pembrolizumab being a standard treatment option in patients with advanced/mNSCLC and TPS for PD-L1 expression of 50% 1.
- Small cell lung cancer typically requires chemotherapy (etoposide with cisplatin/carboplatin) and often radiation.
- Treatment selection is based on cancer histology, molecular testing results, disease stage, and the patient's performance status, with multidisciplinary teams typically coordinating care for optimal outcomes. Key considerations in treatment selection include the patient's overall health, potential side effects of treatment, and the presence of specific genetic mutations that may influence treatment response.
- Recent studies have shown that immunotherapy combinations, such as pembrolizumab with platinum-based chemotherapy, can improve overall survival and response rates in patients with advanced NSCLC 1.
- The choice of treatment should be individualized based on the patient's specific needs and circumstances, with a focus on improving overall survival, quality of life, and minimizing treatment-related toxicity. In summary, the treatment of malignant neoplasm of the lung requires a comprehensive and multidisciplinary approach, taking into account the latest evidence and guidelines to optimize patient outcomes.
From the FDA Drug Label
The efficacy and safety of DOCIVYX has been evaluated in patients with unresectable, locally advanced or metastatic non-small cell lung cancer whose disease has failed prior platinum-based chemotherapy or in patients who are chemotherapy naive Monotherapy with DOCIVYX for NSCLC Previously Treated with Platinum-Based Chemotherapy Two randomized, controlled trials established that a DOCIVYX dose of 75 mg/m2 was tolerable and yielded a favorable outcome in patients previously treated with platinum-based chemotherapy Combination Therapy with DOCIVYX for Chemotherapy-Naive NSCLC In a randomized controlled trial (TAX326), 1218 patients with unresectable stage IIIB or IV NSCLC and no prior chemotherapy were randomized to receive one of three treatments: DOCIVYX 75 mg/m2 as a 1-hour infusion immediately followed by cisplatin 75 mg/m2 over 30 to 60 minutes every 3 weeks
The treatment options for malignant neoplasm of the lung include:
- Monotherapy with docetaxel (DOCIVYX) 75 mg/m2 for patients with unresectable, locally advanced or metastatic non-small cell lung cancer (NSCLC) previously treated with platinum-based chemotherapy
- Combination therapy with DOCIVYX 75 mg/m2 and cisplatin for chemotherapy-naive patients with unresectable stage IIIB or IV NSCLC
- Combination therapy with DOCIVYX 75 mg/m2 and carboplatin for chemotherapy-naive patients with unresectable stage IIIB or IV NSCLC 2 2
From the Research
Treatment Options for Malignant Neoplasm of the Lung
The treatment options for malignant neoplasm of the lung, specifically non-small cell lung cancer (NSCLC), include:
- Surgery: regarded as the primary treatment modality for early stage NSCLC 3, 4
- Adjuvant chemotherapy: becomes standard in early stage NSCLC, at least for stage II and resected IIIA NSCLC, with cisplatin-based adjuvant chemotherapy showing 5-year survival improvements of 5% to 10% 3, 5, 4
- Radiotherapy: should be offered in patients with N2 lymph nodes 4
- Chemotherapy: a multidisciplinary treatment consisting of 4 cycles of cisplatin-based chemotherapy plus a 3rd generation cytotoxic agent or a cytostatic (anti-EGFR, anti-VEGFR) drug for advanced stage IIIB/IV or inoperable NSCLC patients 4
- Immunotherapy: a promising approach for patients with stage I-III NSCLC, with immune checkpoint inhibitor immunotherapy showing recent breakthroughs in metastatic NSCLC 6
- Targeted therapy: customized for each patient based on the specific medical condition and other variables, with targeted treatments achieving improvement in recent years 7
Stages of NSCLC and Corresponding Treatments
The stages of NSCLC and corresponding treatments are:
- Stage I: radical surgery is the standard of care for fit patients, with adjuvant treatment offered only as part of an investigation trial 4
- Stage II and IIIA: adjuvant cisplatin-based chemotherapy remains the gold standard for completely resected NSCLC tumors 4
- Stage IIIB/IV or inoperable: a multidisciplinary treatment consisting of 4 cycles of cisplatin-based chemotherapy plus a 3rd generation cytotoxic agent or a cytostatic (anti-EGFR, anti-VEGFR) drug 4
Importance of Accurate Sub-Classification
Accurate sub-classification of NSCLC is critical for tailored treatment, according to the latest World Health Organization standards 7