Drug therapy today is an essential modality for treating both small cell and non-small cell lung cancer.
- Small cell lung cancer is more sensitive to chemotherapy than non-small cell. Chemotherapy is often the first choice of treatment either combined with radiation therapy (localized cancer) or alone (extensive cancer).
- For non-small lung cancer, chemotherapy alone is the treatment of choice when the cancer has metastasized. In stage II and III, adjuvant chemotherapy may be offered after surgery, or given in combination with radiation therapy.
For both small cell and non-small cell lung cancer, platinum-based combination regimens are the primary chemotherapy choices.
- For small-cell, etoposide is often given in combination with cisplatin, for both localized and extensive cancer.
- For non-small cell, adjuvant cisplatin and vinorelbine are given together after surgery. Platinum-based chemotherapy is also the first choice in combination with curatively intended radiation therapy, or for extensive cancer in patients without an EGFR mutation.
For metastatic non-small cell lung cancer, a series of palliative regimens are appropriate and in terms of effectiveness, equal. The side effect profile is usually the only differentiating factor, and in Norway, the combination carboplatin/vinorelbin is usually the first choice. For progression after first-line treatment of non-small cell, monotherapy with docetaxel or pemetrexed for non-squamous cell carcinoma can be tried.
Erlotinib, gefitinib or afatinib are now approved as first-line treatment for metastatic disease in EGFR-mutation positive patients. Other molecular targeting substances are in trial phases and patients should be offered inclusion in these studies.
When translocation of the ALK gene is confirmed, ALK inhibitors are appropriate treatment with progression after first-line standard chemotherapy. Crizotinib is approved in this situation. Clinical studies involving ALK-inhibitors are ongoing. Patients can be considered for inclusion in these trials.