METASTATIC NON-SMALL CELL LUNG CANCER

Treatment of Metastatic Non-Small Cell Lung Cancer



Treatment of Metastatic Non-Small Cell Lung Cancer

Introduction

The paper paper describes about the patient, named Ernesto, who is a 66 year old man, who has metastatic non-small cell lung cancer (NSCLC) diagnosed recently. He presented with cough and haemoptysis. He is recommenced the palliative chemotherapy. The following paper describes about the treatment of patient with the chemotherapeutic agents. It describes about various combination chemotherapeutic agents, their benefits, advantages, disadvantages, side-effects, monitoring of treatment response and counseling of patient prior to treatment. The paper describes about various combination chemotherapy agents and describes how to councel the patient before the treatment/

Discussion

This type of cancer is very common in most area\s of world and seen in men and women. Lung cancer arises can be divided into small cell lung cancer and non-small cell lung cancer; 80% are NSCLC and 20% of tumours are SCLC. There are three types of NSCLC:

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma.

Adenocarcinoma has glandular structure and produces a fluid called mucin. They accounts for 40% of all lung cancers and 55% of non-small cell lung cancers. Its variants are acinar adenocarcinoma, bronchioloalveolar adenocarcinoma, papillary adenocarcinoma, etc. This form of cancer is also seen in young people. This causes scarring of the lung .

Squamous cell carcinoma is mostly seen in men who are smokers. It contains large, flat cells and produces keratin. It occurs 5-30% in lung carcinomas and occurs in old age. Large Cell Carcinoma contains large cells, which are undifferentiated in appearance . It occurs 10-15% of lung carcinomas. Its variants are basaloid LCC, clear cell LCC, and large cell neuroendocrine carcinoma (Lilenbaum, Herndon, & List, 2005, pp. 190-6).

Treatment

Treatment of NSCLC is a complex process depends on the stage and associated factors. Before starting treatment, following things are considered.

The number of lymph nodes metastasized by NSCLC.

Performance status (PS)

Distant metastasis

Co-morbids.

There are many options available to treat the NSCLC, depending upon patient's condition, prognosis and associated diseases; the patients are offered various options depending upon their stage of disease. These options are chemotherapy , radiation, surgery, and other symptomatic therapy. Other treatment modalities are:

Combination chemotherapy with platinum, carboplatin , paclitaxel, cisplatin vinorelbine, gemcitabine, docetaxel, and pemetrexed.

Combination therapy with cetuximab or bevacizumab.

EGFR tyrosine kinase inhibitors.

EML4-ALK inhibitors.

Endobronchial laser therapy

Brachytherapy

External-beam radiation therapy (Di Maio, Chiodini, & Georgoulias, 2009, pp. 1836-1843).

Chemotherapy Combinations

There are various chemotherapy regimens for cancer treatment, some are used alone, and some are used in combinations. Most commonly used chemotherapeutic agents are

Docetaxel

Gefitinib

Gemcitabine

Irinotecan (CPT-11)

Paclitaxel

Topotecan

Vinorelbine

5-fluorouracil (5-FU)

Carboplatincisplatin

Cyclophosphamide

Doxorubicin

Mitomycin

Teniposide

Vincristine (Di Maio, Chiodini, & Georgoulias, 2009, pp. 1836-1843).

Platinum Combinations

Platinum combinations with docetaxel, paclitaxel, vinorelbine, gemcitabine and pemetrexed improves survival. Adenocarcinoma may improve by taking pemetrexed. Carboplatinum and Cisplatin improve outcomes. Platinum-based combination improves survival and quality of life. It is also helpful in controlling symptoms. Non-platinum combinations does not offer advantage over platinum (D'Addario, Pintilie, & Leighl, 2005, pp. 2926-36). Other chemotherapy agents used in combination are:

Erlotinib and Gefitinib 

These are chemotherapy drugs that inhibit epidermal growth ...