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Chemotherapy in the Treatment of Lung Cancer

A number of chemotherapeutic regimens can be used to treat non-small cell lung cancer. These are usually reserved 1) for higher stages of lung cancer (stages III and IV) or 2) as adjuvant therapy, that is, to be used after surgery or 3) as neoadjuvant therapy, which is treatment before surgery. Neoadjuvant therapy is done to make the tumor smaller so that surgery will be easier or more effective. Adjuvant therapy is performed to kill cancer cells that may have been missed in the surgery or spread from the primary tumor.

The standard of care in the treatment of NSCLC is to use a platinum-based chemotherapeutic agent, especially in advanced disease (stages III and especially IV). Most studies have shown that two agents are better than one. Three agents used in combination do not provide much additional benefit but do cause a number of additional, unpleasant side effects. Therefore chemotherapy regimens usually include two drugs. Often this combination regimen includes a platinum drug like cisplatin along with either an older (etoposide) or newer (docetaxel, gemcitabine, pemetrexed (Alimta) or vinorelbine) chemotherapeutic drug.

Chemotherapy is used to treat both limited and extensive small cell lung cancer. In limited disease, patients have been successfully treated with a single chemotherapeutic drug (when combined with radiation). In most cases though, two drugs are used rather than one. These two drugs are commonly a platinum drug and etoposide. In extensive SCLC, two chemotherapeutic drugs are used. The specific chemotherapeutic agents used in extensive SCLC vary.

The following table lists drugs approved by the Food & Drug Administration (FDA) for use in both non-small cell and small cell lung cancers. It is important to keep in mind that this list may not be all-inclusive, and that new drugs are approved on a regular basis. Your best source of information on any drug or combination of drugs recommended for use in your particular case is your Medical Oncologist.

FDA-approved Drugs for Use in Non-small Cell and Small Cell Lung Cancers
Approved for: Generic Name Brand Name(s)
Non-small cell Methotrexate Abitrexate, Folex, Folex PFS, Methotrexate LPF, Mexate, Mexate A-Q
Non-small cell Pemetrexed Disodium Alimta
Non-small cell Bevacizumab Avastin
Non-small cell Carboplatin Paraplat, Paraplatin
Non-small cell Cisplatin Platinol, Platinol A-Q
Non-small cell Erlotinib Hydrochloride Tarceva
Non-small cell Gefitinib Iressa
Non-small cell Gemcitabine Hydrochloride Gemzar
Non-small cell Paclitaxel Taxol
Small cell Methotrexate Abitrexate, Folex, Folex PFS, Methotrexate LPF, Mexate, Mexate A-Q
Small cell Etoposide Phosphate Etopophos
Small cell Etoposide Toposar, VePesid
Small cell Topotecan Hydrochloride Hycamtin


Both NSCLC and SCLC patients may be possible to enroll in a clinical trial of lung cancer treatments. These trials usually compare new therapies against older ones to see if outcomes can be improved. Targeted therapies, radiosensitizers, internal radiation sources, and newer combination treatment regimens are just some of the treatment tools being tested in research and clinical studies. These new treatments may improve survival or may lead to future breakthroughs. Note that crizotinib (Xalkori) was recently approved for treatment of ALK (anaplastic lymphoma kinase) positive advanced stage lung cancer.

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