Treatment

TREATMENT OPTIONS BY STAGE

Occult Non-Small Cell Lung Cancer

Treatment of occult non-small cell lung cancer depends on where the cancer has spread. It can usually be cured by surgery.

Stage 0 Non-Small Cell Lung Cancer

Treatment of stage 0 non-small cell lung cancer may include the following:

• Surgery to remove the tumor and a small amount of normal tissue around it.
• Photodynamic therapy using an endoscope.

Stage I Non-Small Cell Lung Cancer

Treatment of stage I non-small cell lung cancer may include the following:

• Surgery to remove part or the whole lobe of a lung.
• External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
• Surgery followed by chemotherapy.

Stage II Non-Small Cell Lung Cancer

Treatment of stage II non-small cell lung cancer may include the following:

• Surgery to remove part or an entire lung.
• External radiation therapy (for patients who cannot have surgery or choose not to have surgery).
• Surgery followed by chemotherapy, with or without other treatments.

Stage IIIA and Stage IIIB Non-Small Cell Lung Cancer

Treatment of stage IIIA non-small cell lung cancer may include the following:

• Surgery with or without radiation therapy.
• External radiation therapy alone.
• Chemotherapy combined with other treatments.

Treatment of stage IIIB non-small cell lung cancer may include the following:

• External radiation therapy alone.
• Chemotherapy combined with external radiation therapy.
• Chemotherapy combined with external radiation therapy, followed by surgery.
• Chemotherapy alone.

Stage IV Non-Small Cell Lung Cancer

Treatment of stage IV non-small cell lung cancer may include the following:

• Watchful waiting.
• External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life.
• Chemotherapy.
• Laser therapy and/or internal radiation therapy.

Limited-Stage Small Cell Lung Cancer

Treatment of limited-stage small cell lung cancer may include the following:

• Combination chemotherapy and radiation therapy to the chest, with or without radiation therapy to the brain.
• Combination chemotherapy with or without radiation therapy to the brain in patients with complete response.
• Combination chemotherapy with or without radiation therapy to the chest.
• Surgery followed by chemotherapy or chemotherapy plus radiation therapy to the chest, with or without radiation therapy to the brain.

Extensive-Stage Small Cell Lung Cancer

Treatment of extensive-stage small cell lung cancer may include the following:

• Chemotherapy.
• Combination chemotherapy.
• Combination chemotherapy with or without radiation therapy to the brain for patients with complete response.

Radiation therapy to the brain, spine, bone, or other parts of the body where the cancer has spread, as palliative therapy to relieve symptoms and improve quality of life.

Targeted therapy

In recent years, various molecular targeted therapies have been developed for the treatment of advanced lung cancer. Gefitinib (Iressa) is one such drug, which targets the epidermal growth factor receptor (EGFR) which is expressed in many cases of NSCLC. However despite an exciting start it was not shown to increase survival, although females, Asians, non-smokers and those with the adenocarcinoma cell type appear to be deriving most benefit from gefitinib.

A newer drug called erlotinib (Tarceva) has been shown to increase survival in lung cancer patients and has recently been approved by the FDA for second-line treatment of advanced non-small cell lung cancer. Similar to gefitinib, it appeared to work best in females, Asians, non-smokers and those with the adenocarcinoma cell type.

Treatment of non-small cell lung cancer is evolving and the next few years could present exciting developments and new targeted therapies for lung cancer.

Reference:

National Cancer Institute, USA.