Chemotherapy in lung cancer

Chemotherapy in non-small cell lung cancer:

• generally unrewarding - few patients show a good response and many suffer toxic side-effects
• drug combinations such as mitomycin, ifosfamide and cisplatin have recently shown responses in more than half of patients who presented with limited disease (disease confined to one hemithorax)
• meta-analysis of seven studies comparing chemotherapy with the best supportive care has revealed a significantly greater survival and quality of life during the first six months after chemotherapy

Chemotherapy in small-cell lung cancer:

• main form of therapy in small-cell lung cancer
• six courses of combination chemotherapy are adequate and optimal for most patients
• 80-90% response rates after combination chemotherapy but the long-term prognosis remains poor (8% 2 year survival if presents with limited disease; 2% 2 year survival if presents with extensive disease)
• chemotherapeutic tumour resolution improves symptoms such as dyspnoea, pain, anorexia, breathlessness and haemoptysis in 2/3 of patients
• radiotherapy to the mediastinum and primary tumour site after a good, ideally complete, response to chemotherapy leads to a further increased chance of long-term survival
• NICE state that (1):
  • oral topotecan is recommended as an option only for people with relapsed small-cell lung cancer for whom:
    • re-treatment with the first-line regimen is not considered appropriate and
    • the combination of cyclophosphamide, doxorubicin and vincristine (CAV) is contraindicated
  • intravenous topotecan is not recommended for people with relapsed small-cell lung cancer

Reference:

• 1) NICE (November 2009). Topotecan for the treatment of relapsed small-cell lung cancer