Lung Cancer Treatment Regimens

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LUNG CANCER TREATMENT REGIMENS

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are only provided to supplement the latest treatment strategies.

These Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

Non-Small Cell Lung Cancer (NSCLC)

Chemotherapy Regimens For Neoadjuvant and Adjuvant Therapy1

REGIMEN

DOSING

Cisplatin + vinorelbine2–4

Days 1 and 8: Cisplatin 50mg/m2 IV plus

Days 1, 8, 15 and 22: Vinorelbine 25mg/m2 IV.

Repeat cycle every 4 weeks for 4 cycles.

OR

Day 1: Cisplatin 100mg/m2 IV plus

Days 1, 8, 15 and 22: Vinorelbine 30mg/m2 IV.

Repeat cycle every 4 weeks for 4 cycles.

OR

Day 1: Cisplatin 75–80mg/m2 plus

Days 1 + 8: Vinorelbine 25–30mg/m2.

Repeat every 3 weeks for 4 cycles.

Cisplatin + etoposide3

Day 1: Cisplatin 100mg/m2 IV plus

Days 1–3: Etoposide 100mg/m2 IV.

Repeat cycle every 4 weeks for 4 cycles.

Cisplatin + vinblastine3

Days 1, 22, 43, 64: Cisplatin 80mg/m2 IV.

Days 1, 8, 15, 22, 29, and then every 2 weeks after day 43: Vinblastine 4 mg/m2.

Repeat every 3 weeks for 4 cycles.

Cisplatin + gemcitabine5

Day 1: Cisplatin 75mg/m2 IV plus

Days 1 and 8: Gemcitabine 1,250mg/m2 IV.

Repeat cycle every 3 weeks.

Cisplatin + docetaxel6

Day 1: Docetaxel 75mg/m2 IV + cisplatin 75mg/m2 IV.

Repeat every 3 weeks for 4 cycles.

Cisplatin + pemetrexed7,8

Day 1: Cisplatin 75mg/m2 IV + pemetrexed 500mg/m2 IV.*

Repeat every 3 weeks for 4 cycles.

For patients with comorbidities or patients not able to tolerate cisplatin1

Paclitaxel + carboplatin9

Day 1: Paclitaxel 200mg/m2 IV + carboplatin AUC=6 IV.

Repeat cycle every 3 weeks for 4 cycles.

Concurrent Chemotherapy/Radiotherapy (RT)1

Cisplatin + etoposide10,† (preferred regimen)

Days 1, 8, 29 and 36: Cisplatin 50mg/m2 IV plus

Days 1–5 and 29–33: Etoposide 50mg/m2 IV plus

Concurrent thoracic radiotherapy 1.8Gy/day for 5 days/week (total dose, 61Gy).

Cisplatin + vinblastine (preferred regimen)11

Days 1 and 29: Cisplatin 100mg/m2 IV plus

Days 1, 8, 15, 22 and 29: Vinblastine 5mg/m2 IV with concurrent thoracic radiotherapy (total dose, 60Gy).

Carboplatin + pemetrexed (nonsquamous)12

Day 1: Carboplatin AUC 5 IV plus

Day 1: Pemetrexed 500 mg/m2 IV with concurrent thoracic radiotherapy.

Repeat every 3 weeks for 4 cycles.

Cisplatin + pemetrexed (nonsquamous)7,8

Day 1: Cisplatin 75 mg/m2 IV.

Day 1: Pemetrexed 500 mg/m2 IV with concurrent thoracic radiotherapy.

Repeat every 3 weeks for 3 cycles.

Sequential Chemotherapy/ Radiotherapy (RT)1

Cisplatin + vinblastine11

Days 1 and 29: Cisplatin 100mg/m2 IV.

Days 1, 8, 15, 22 and 29: Vinblastine 5mg/m2 IV; followed by thoracic radiotherapy with 60Gy in 30 fractions beginning on Day 50.

Paclitaxel + carboplatin13

Day 1: Paclitaxel 200mg/m2 IV over 3 hours + carboplatin AUC=6 IV over 1 hour.

Repeat every 3 weeks for 2 cycles; followed by thoracic radiotherapy 63Gy beginning on Day 42.

Concurrent Chemotherapy/ Radiotherapy (RT) Followed by Chemotherapy1

Paclitaxel + carboplatin13

Day 1 (weekly): Paclitaxel 45–50mg/m2 IV and carboplatin AUC=2 IV.

Concurrent thoracic radiotherapy; followed by two additional cycles of paclitaxel 200mg/m2 IV and carboplatin AUC=6 IV.

Cisplatin + etoposide10

Days 1, 8, 29, and 36: Cisplatin 50mg/m2 IV.

Days 1–5, 29–33: Etoposide 50mg/m2 IV with concurrent thoracic radiotherapy; followed by two additional cycles of cisplatin 50mg/m2 IV and etoposide 50mg/m2 IV.

Systemic Therapy for Advanced Disease1

• The drug regimen with the highest likelihood of benefit, with toxicity deemed acceptable to both the physician and the patient, should be given as initial therapy for advanced lung cancer.

• Stage, weight loss, performance status (PS), and gender predict survival.

• Platinum-based chemotherapy prolongs survival, improves symptom control, and yields superior quality of life compared to best supportive care.

• Histology of NSCLC is important in the selection of systemic therapy.

• New agent/platinum combinations have generated a plateau in overall response rate ( 25%–35%), time to progression (4–6 months), median survival (8–10 months), 1-year survival rate (30%–40%), and 2-year survival rate (10%–15%) in fit patients.

• Unfit patients of any age (PS 3–4) do not benefit from cytotoxic treatment, except erlotinib for those who are epidermal growth factor receptor (EGFR) mutation-positive.

Principals of Maintenance Therapy1

Continuation maintenance refers to the use of at least one of the agents given in first line, beyond 4 to 6 cycles, in the absence of disease progression. Switch maintenance refers to the initiation of a different agent, not included as part of the first-line regimen, in the absence of disease progression, after 4 to 6 cycles of initial therapy.

Continuation Maintenance: Bevacizumab and cetuximab given in combination with chemotherapy should be continued until evidence of disease progression or unacceptable toxicity, as per the design of the clinical trials supporting their use.

> Continuation of bevacizumab after 4–6 cycles of platinum-doublet chemotherapy and bevacizumab (category 1).

> Continuation of cetuximab after 4–6 cycles of cisplatin, vinorelbine, and cetuximab (category 1).

> Continuation of pemetrexed after 4–6 cycles of cisplatin and pemetrexed chemotherapy, for patients with histologies other than squamous cell carcinoma (category 1).

> Continuation of bevacizumab + pemetrexed after 4–6 cycles of bevacizumab, pemetrexed, cisplatin/carboplatin, for patients with histologies other than squamous cell carcinoma.

> Continuation of gemcitabine after 4–6 cycles of platinum-doublet chemotherapy (category 2B).

Switch Maintenance: Two studies have shown a benefit in progression-free and overall survival with the initiation of pemetrexed or erlotinib after first-line chemotherapy, in patients without disease progression after 4–6 cycles of therapy.

> Initiation of pemetrexed after 4–6 cycles of first-line platinum-doublet chemotherapy for patients with histologies other than squamous cell carcinoma (category 2B).

> Initiation of erlotinib after 4–6 cycles of first-line platinum-doublet chemotherapy (category 2B).

> Initiation of docetaxel after 4–6 cycles of first-line platinum-doublet chemotherapy in patients with squamous cell carcinoma (category 2B).

> Close surveillance of patients without therapy is a reasonable alternative to maintenance.


Principles of Third-Line Therapy1

• If not already given, options for patients with PS 0–2 include docetaxel, pemetrexed (nonsquamous), erlotinib, or gemcitabine (category 2B for all options).


Continuation After Disease Progression1

• With the exception of targeted agents (erlotinib, gefitinib, afatinib, crizotinib) in patients with EGFR-sensitizing mutations or ALK rearrangements who have experienced objective regressions with targeted therapy, no agent should be continued after disease progression has been documented except in selected situations. (refer to discussion section of NCCN Guidelines for Non-Small Cell Lung Cancer v.3.2014)


Systemic Treatment Options for Patients with NSCLC1,‡

Cisplatin14–21                              • Etoposide17                         • Erlotinib25

Carboplatin17,18–23                      • lrinotecan20                         • Bevacizumab26

Paclitaxel14,17,18,20–23                   • Vinblastine                         • Cetuximab27

Docetaxel5,6,19,23,24                      • Mitomycin                           • Albumin-bound paclitaxel28–30§

Vinorelbine6,20,21                         • Ifosfamide23                        • Crizotinib31

Gemcitabine5,16,18–20,24               • Pemetrexed7,8                     • Afatinib32

First-Line Systemic Therapy for Advanced Disease1

REGIMEN

DOSING

Bevacizumab carboplatin + paclitaxel26,33

Day 1: Paclitaxel 200mg/m2 IV

Day 1: Carboplatin AUC=6 IV.

Repeat every 3 weeks for 6 cycles.

Day 1: Bevacizumab 15mg/kg IV every 3 weeks until disease progression.

Cetuximab + cisplatin + vinorelbine27,||

Day 1: Cetuximab 400mg/m2 IV + cisplatin 80mg/m2 IV, plus

Days 1 and 8: Vinorelbine 25mg/m2 IV, plus

Day 8: Cetuximab 250mg/m2 IV once weekly.

Repeat every 3 weeks for 6 cycles.

Erlotinib34,35,¶

Day 1: Erlotinib 150mg PO once daily; following 4 cycles of platinum-based chemotherapy.

Cisplatin + paclitaxel19

Day 1: Paclitaxel 135mg/m2 IV over 24 hours

Day 2: Cisplatin 75mg/m2 IV.

Repeat cycle every 3 weeks.

Cisplatin + gemcitabine19

Day 1: Cisplatin 100mg/m2 IV

Days 1, 8 and 15: Gemcitabine 1,000mg/m2 IV.

Repeat cycle every 4 weeks.

Cisplatin + docetaxel6

Day 1: Cisplatin 75mg/m2 IV + docetaxel 75mg/m2 IV.

Repeat cycle every 3 weeks.

Cisplatin + vinorelbine6

Day 1: Cisplatin 100mg/m2 IV

Days 1, 8, 15 and 22: Vinorelbine 25mg/m2 IV over 10 minutes.

Repeat cycle every 4 weeks.

Carboplatin + paclitaxel19

Day 1: Carboplatin AUC=5–6 IV

Day 1: Paclitaxel 225mg/m2 IV over 3 hours.

Repeat cycle every 3 weeks.

Pemetrexed + cisplatin24,36

Day 1: Pemetrexed 500mg/m2 IV + cisplatin 75mg/m2 IV.

Repeat cycle every 3 weeks.

Crizotinib37,#

Crizotinib 250mg PO twice daily.**

Principals of First-Line Therapy1

• Bevacizumab + chemotherapy or chemotherapy alone is indicated in patients with PS 0–1 with advanced or recurrent NSCLC. Bevacizumab should be given until disease progression.

• Cetuximab + vinorelbine/cisplatin is an option for patients with PS 0–1 (category 2B).

• Erlotinib is recommended as a first-line therapy in patients with sensitizing EGFR mutations and should not be given as first-line therapy to patients negative for these EGFR mutations or with unknown EGFR status.

• Afatinib is indicated for select patients with sensitizing EGFR mutations.

• Crizotinib is indicated for select patients with ALK rearrangements.

• There is superior efficacy and reduced toxicity for cisplatin/pemetrexed in patients with nonsquamous histology compared with cisplatin/gemcitabine.

• There is superior efficacy for cisplatin/gemcitabine in patients with squamous histology, in comparison to cisplatin/pemetrexed.

• Two drug regimens are preferred; a third cytotoxic drug increases response rate but not survival.

• Single-agent therapy or platinum-based combinations are a reasonable alternative in PS 2 patients or the elderly.

• Cisplatin or carboplatin have been proven effective in combination with any of the following agents: paclitaxel, docetaxel, gemcitabine, etoposide, vinblastine, vinorelbine, pemetrexed, or albumin-bound paclitaxel.

• New agent/non-platinum combinations are reasonable alternatives if available data show activity and tolerable toxicity (e.g., gemcitabine/docetaxel, gemcitabine/vinorelbine).

Second-Line Systemic Therapy for Advanced Disease1

Docetaxel23

Day 1: Docetaxel 75mg/m2 IV.

Repeat cycle every 3 weeks.

Pemetrexed7

Day 1: Pemetrexed 500mg/m2 IV.

Repeat cycle every 3 weeks.

Erlotinib25

Day 1: Erlotinib 150mg PO once daily.

Principles of Second-Line Therapy1

• In patients who have experienced disease progression either during or after first-line therapy, single-agent docetaxel, pemetrexed, or erlotinib are established second-line agents.

> Docetaxel is superior to vinorelbine or ifosfamide.

> Pemetrexed is considered equivalent to docetaxel with less toxicity in patients with adenocarcinoma and large cell carcinoma.

> Erlotinib is superior to best supportive care.

> Afatinib is indicated for select patients with sensitizing EGFR mutations.

Third-Line Systemic Therapy for Advanced Disease1

Erlotinib25

Day 1: Erlotinib 150mg PO once daily.

Principles of Third-Line Therapy1

• If not already given, options for patients with PS 0–2 include docetaxel, pemetrexed (nonsquamous), erlotinib, or gemcitabine (category 2B for all options).

Continuation After Disease Progression1

• With the exception of targeted agents (erlotinib, gefitinib, afatinib, crizotinib) in patients with EGFR-sensitizing mutations or ALK rearrangements who have experienced objective regressions with targeted therapy, no agent should be continued after disease progression has been documented except in selected situations (refer to discussion section of NCCN Guidelines for Non-Small Cell Lung Cancer v.3.2014).

Small Cell Lung Cancer (SCLC)

Chemotherapy as Primary or Adjuvant Therapy‡‡

Limited Stage (maximum of 4–6 cycles)1

Cisplatin + etoposide38–40,§§

Day 1: Cisplatin 60mg/m2 IV plus

Days 1–3: Etoposide 120mg/m2 IV.

Repeat cycle every 3 weeks for at least 4 cycles.

OR

Day 1: Cisplatin 80mg/m2 IV plus

Days 1–3: Etoposide 100mg/m2 IV.

Repeat every 4 weeks for 4–6 cycles.

Carboplatin + etoposide41

Day 1: Carboplatin AUC=5–6 IV plus

Days 1–3: Etoposide 100mg/m2 IV.

Repeat every 3 weeks for 4–6 cycles.

Extensive Stage (maximum of 4–6 cycles)1

Cisplatin + etoposide42–44

Day 1: Cisplatin 75–80mg/m2 IV

Days 1–3: Etoposide 80–100mg/m2 IV.

Repeat every 3 weeks for 4–6 cycles.

Cisplatin + irinotecan38,45,46

Day 1: Cisplatin 60mg/m2 IV

Days 1, 8 and 15: Irinotecan 60mg/m2 IV.

Repeat cycle every 4 weeks for 4 cycles.

OR

Day 1 and 8: Cisplatin 30mg/m2 IV

Day 1 and 8: Irinotecan 65mg/m2 IV.

Repeat every 3 weeks for 4–6 cycles.

Carboplatin + irinotecan47

Day 1: Carboplatin AUC=5 IV plus

Days 1, 8 and 15: Irinotecan 50mg/m2 IV.

Repeat cycle every 4 weeks for 4–6 cycles.

Carboplatin + etoposide48

Day 1: Carboplatin AUC=5–6 IV.

Days 1–3: Etoposide 100mg/m2 IV.

Repeat every 4 weeks for 4–6 cycles.

Subsequent Chemotherapy

Relapse <2–3 months, PS 0–21

Paclitaxel18,49

Day 1: Paclitaxel 175mg/m2 IV over 3 hours plus

Day 1: Cisplatin 80mg/m2 IV.

Repeat every 3 weeks for at least 2 cycles.

OR

Day 1: Paclitaxel 80mg/m2 IV over 1 hour.

Repeat every week for 6 weeks, followed by a 2-week break.

Docetaxel50

Day 1: Docetaxel 100mg/m2 IV over 1 hour.

Repeat every 21 days.

Topotecan51–53

Days 1–5: Topotecan 1.5mg/m2 IV once daily over 30 minutes.

Repeat every 3 weeks.

OR

Days 1–5: Topotecan 2.3mg/m2 PO once daily.

Repeat every 3 weeks.

Irinotecan55

Day 1: Irinotecan 100mg/m2 IV over 90 minutes.

Repeat every week.

Temozolomide56

Day 1–21: Temozolomide 75mg/m2 PO for a 4-week cycle.

Gemcitabine57,58

Days 1, 8, and 15: Gemcitabine 1,000mg/m2 IV for a 4-week cycle.

Ifosfamide59

Day 1: Ifosfamide/mesna 5,000mg/m2 IV.

Repeat every 3 weeks.

Relapse > 2–3 months up to 6 months1

Topotecan51–54

Days 1–5: Topotecan 1.5mg/m2 IV once daily over 30 minutes.

Repeat every 3 weeks.

OR

Days 1–5: Topotecan 2.3mg/m2 PO once daily.

Repeat every 3 weeks.

Paclitaxel18,49

Day 1: Paclitaxel 175mg/m2 IV over 3 hours plus

Day 1: Cisplatin 80mg/m2.

Repeat every 3 weeks for at least 2 cycles.

OR

Day 1: Paclitaxel 80mg/m2 IV over 1 hour.

Repeat every week for 6 weeks, followed by a 2-week break.

Docetaxel50

Day 1: Docetaxel 100 mg/m2 IV over 1 hour.

Repeat every 21 days.

Irinotecan55

Day 1: Irinotecan 100mg/m2 IV over 90 minutes.

Repeat every week.

Gemcitabine57,58

Days 1, 8, and 15: Gemcitabine 1,000mg/m2 IV for a 4-week cycle.

Vinorelbine60,61

Day 1: Vinorelbine 25–30mg/m2 IV.

Repeat every week

Etoposide (PO)62,63

Day 1–21: Etoposide 50mg/m2 PO.

Temozolomide 75 mg/m2/day × 21 days56

Day 1–21: Temozolomide 75mg/m2 PO for a 4-week cycle.

Cyclophosphamide/doxorubicin/ vincristine (CAV)51

Day 1: Cyclophosphamide 1,000 mg/m2 IV plus

Day 1: Doxorubicin 45mg/m2 IV plus

Day 1: Vincristine 2mg IV.

Repeat every 21 days.

Relapse> 6 months1

Original regimen64,65,||||

* For adenocarcinoma, large cell carcinoma, and NSCLC NOS without specific histologic subtype.

This regimen can be used as neoadjuvant chemoradiotherapy. Cisplatin and etoposide is the preferred regimen. If weekly carboplatin and paclitaxel is used because the patient is not able to tolerate concurrent full-dose cisplatin and radiotherapy, the treating physician should consider 2 cycles of full-dose platinum therapy after local treatment is completed.

Most are used in combination, while others are used as monotherapy (e.g., maintenance or second-line therapy).

§ Albumin-bound paclitaxel may be substituted for either paclitaxel or docetaxel in patients who have experienced hypersensitivity reactions after receiving paclitaxel or docetaxel despite premedication, or for patients where the standard premedications (dexamethasone, H2 blockers, H1 blockers) are contraindicated.

|| Indicated in advanced NSCLC.

Indicated for EGFR mutation–positive patients and may be considered as an option for patients who test positive for an EGFR mutation.

# Indicated for ALK-positive patients.

** May reduce to 200mg twice daily not tolerated or toxicity occurs. If further reduction is needed, reduce to 250mg once daily.

†† The regimens included are representative of the more commonly used regimens for small cell lung cancer. Other regimens may be acceptable.

‡‡ The use of rnyeloid growth factors is not recommended during concurrent chemotherapy plus radiotherapy.

§§ During chemotherapy + radiotherapy, cisplatin/etoposide is recommended (1).

|||| Consider dose reductions versus growth factors in the poor performance status patient.

References

1. Referenced with permission from NCCN Clinical Practice Guidelines in Oncology™ Non-Small Cell Lung Cancer. v 3.2014. Available at: http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. and Small Cell Lung Cancer. v 2.2014. Available at: http://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed April 14, 2014.

2. Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-lung cancer. N Engl J Med. 2005;352:2589–2597.

3. Arriagada R, Bergman B, Dunant A, et al. The International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small cell lung cancer. N Engl J Med. 2004;350: 351–360.

4. Douillard JY, Rosell R, De Lena M, et al. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol. 2006;7:719–727.

5. Sandler AB, Nemunaitis J, Denham C, et al. Phase III trial of gemcitabine plus cisplatin versus cisplatin alone in patients with locally advanced or metastatic non-small cell lung cancer. J Clin Oncol. 2000;18:122–130.

6. Fossella F, Pereira JR, von Pawel J, et al. Randomized, multi- national, phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for advanced non-small cell lung cancer: the TAX 326 study group. J Clin Oncol. 2003;21: 3016–3024.

7. Hanna NH, Sheperd FA, Fossella FV, et al. Randomized phase III study of pemetrexed versus docetaxel in patients with non-small cell lung cancer previously treated with chemotherapy. J Clin Oncol. 2004;22:1589–1597.

8. Scagliotti GV, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage NSCLC. J Clin Oncol. 2008;26:3543–3551.

9. Strauss GM, Herndon JE III, Maddaus MA, et al. Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study groups. J Clin Oncol. 2008;26:5043–5051.

10. Albain KS, Crowley JJ, Turrisi AT III, et al. Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small cell lung cancer: a Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol. 2002;20:3454–3460.

11. Curran WJ, Scott CB, Langer CJ, et al. Long-term benefit is observed in a phase III comparison of sequential vs concurrent chemoradiation for patients with unresectable stage III NSCLC: RTOG 94–10. Proc Am Soc Clin Oncol. 22:621a, 2003 (abstr 2499).

12. Govindan R, Bogart J, Stinchcombe T, et al. Randomized phase II study of pemetrexed, carboplatin, and thoracic radiation with or without cetuximab in patients with locally advanced unresectable non-small cell lung cancer: Cancer and Leukemia Group B trial 30407. J Clin Oncol. 2011;29:3120–3125.

13. Belani CP, Choy H, Bonomi P, et al. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol. 2005; 23:5883–5891.

14. Bonomi P, Kim K, Fairclough D, et al. Comparison of survival and quality of life in advanced non-small cell lung cancer patients treated with two dose levels of paclitaxel combined with cisplatin versus etoposide with cisplatin: results of an Eastern Cooperative Oncology Group trial. J Clin Oncol. 2000; 18:623–631.

15. Wozniak AJ, Crowley JJ, Balcerzak SP, et al. Randomized trial comparing cisplatin with cisplatin plus vinorelbine in the treatment of advanced non-small cell lung cancer: A Southwest Oncology Group Study. J Clin Oncol. 1998;16: 2459–2465.

16. Cardenal F, Lopez-Cabrerizo MP, Anton A, et al. Randomized phase III study of gemcitabine-cisplatin versus etoposide-cisplatin in the treatment of locally advanced or metastatic non-small cell lung cancer. J Clin Oncol. 1999;17:12–18.

17. Belani CP, Lee JS, Socinski MA, et al. Randomized phase III trial comparing cisplatin-etoposide to carboplatin-paclitaxel in advanced or metastatic non-small cell lung cancer. Ann Oncol. 2005;16:1069–1075.

18. Smit EF, van Meerbeeck JR Lianes P, et al. Three-arm randomized study of two cisplatin-based regimens and paclitaxel plus gemcitabine in advanced non-small cell lung cancer: a phase III trial of the European Organization for Research and Treatment of Cancer Lung Cancer Group-EORTC 08975. J Clin Oncol. 2003; 21:3909–3917.

19. Schiller JH, Harrington D, Belani CR et al. Comparison of four chemotherapy regimens for advanced non-small cell lung cancer.
N EngI J Med. 2002;346:92–98.

20. Ohe Y, Ohashi Y, Kubota K, et al. Randomized phase III study of cisplatin plus irinotecan versus carboplatin plus paclitaxel, cisplatin plus gemcitabine, and cisplatin plus vinorelbine for advanced non-small cell lung cancer: Four-Arm Cooperative Study in Japan. Ann Oncol. 2007;18:317–323.

21. Kelly K, Crowley J, Bunn PA, et al. Randomized phase III trial of paclitaxel plus carboplatin versus vinorelbine plus cisplatin in the treatment of patients with advanced non-small cell lung cancer: A Southwest Oncology Group trial. J Clin Oncol. 2001;19:3210–3218.

22. Belani CP, Ramalingam S, Perry MC, et al. Randomized, phase III study of weekly paclitaxel in combination with carboplatin versus standard every-3-weeks administration of carboplatin and paclitaxel for patients with previously untreated advanced non-small cell lung cancer. J Clin Oncol. 2008;26:468–473.

23. Fossella FV, DeVore R, Kerr RN, et al. Randomized phase III trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small cell lung cancer previously treated with platinum- containing chemotherapy regimens. The TAX 320 Non-Small Cell Lung Cancer Study Group. J Clin Oncol. 2000;18:2354–2362.

24. Pujol JL, Breton JL, Gervais R, et al. Gemcitabine-docetaxel versus cisplatin-vinorelbine in advanced or metastatic non-small cell lung cancer: a phase III study addressing the case for cisplatin. Ann Oncol. 2005;16:602–610.

25. Shepherd FA, Pereira JR, Ciuleanu T, et al. Erlotinib in previously treated non-small cell lung cancer. N EngI J Med. 2005;353: 123–132.

26. Sandler AB, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small cell lung cancer. N EngI J Med. 2006;355:2542–2550.

27. Pirker R, Periera JR, Szczesna A, et al. Cetuximab plus chemotherapy in patients with advanced non-small cell lung cancer (FLEX): an open label randomised phase III trial. Lancet. 2009;373:1525–1531.

28. Green M, Manikhas G, Orlov S, et al. Abraxane®, a novel Cremophor® -free, albumin-bound particle form of paclitaxel for the treatment of advanced non-small cell lung cancer. Ann Oncol. 2006;17:1263–1268.

29. Rizvi N, Riely G, Azzoli, C, et al. Phase I/Il Trial of Weekly Intravenous 130-nm Albumin-Bound Paclitaxel As Initial Chemotherapy in Patients With Stage IV Non-small cell Lung Cancer. J Clin Oncol. 2008;26:639–643.

30. Socinski MA, Bondarenko I, Karaseva NA, et al. Weekly nab-paclitaxel in combination with carboplatin versus solvent-based paclitaxel plus carboplatin as first-line therapy in patients with advanced non-small cell lung cancer: final results of a phase III trial.
J Clin Oncol.
2012:30:2055–2062.

31. Shaw AT, Yeap BY, Solomon BJ, et al. Effect of crizotinib on overall survival in patients with advanced non-small cell lung cancer harbouring ALK gene rearrangement: a retrospective analysis. Lancet Oncol. 2011;12:1004–1012.

32. Sequist LV, Yang JC-H, Yamamoto N, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol. 2013;31(27):3327–3334.

33. Avastin [prescribing information]. South San Francisco, CA: Genentech, Inc.; 2011.

34. Cappuzzo F, Ciuleanu T, Stelmakh L, et al. SATURN investigators. Erlotinib as maintenance treatment in advanced non-small-cell lung cancer: a multicentre, randomised, placebo-controlled phase 3 study. Lancet Oncol. 2010;11:521–529.

35. Tarceva [prescribing information]. S. San Francisco, CA: Genentech, Inc.; 2011.

36. Alimta® [prescribing information]. Indianapolis, IN: Eli Lilly & Co.; 2011.

37. Xalkori [prescribing information]. New York, NY: Pfizer, Inc.; 2011.

38. Hanna N, Bunn PA Jr, Langer C, et al. Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer. J Clin Oncol. 2006;24:2038–2043.

39. Turrisi AT 3rd, Kim K, Blum R, et al. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Eng J Med. 1999;340:265–271.

40. Saito H, Takada Y, Ichinose Y, et al. Phase II study of etoposide and cisplatin with concurrent twice-daily thoracic radiotherapy followed by irinotecan and cisplatin in patients with limited-disease small-cell lung cancer: West Japan Thoracic Oncology Group 9902. J Clin Oncol. 2006;24(33): 5247–5252.

41. Skarlos DV, Samantas E, Briassoulis E, et al. Randomized comparison of early versus late hyperfractionated thoracic irradiation concurrently with chemotherapy in limited disease small-cell lung cancer: a randomized phase II study of the Hellenic Cooperative Oncology Group (HeCOG). Ann Oncol. 2001;12:1231–1238.

42. Ihde DC, Mulshine JL, Kramer BS, et al. Prospective random- ized comparison of high-dose and standard-dose etoposide and cisplatin chemotherapy in patients with extensive-stage small-cell lung cancer. J Clin Oncol. 1994;12:2022–2034.

43. Sundstrom S, Bremnes RM, Kaasa S, et al. Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years' follow-up. J Clin Oncol. 2002;20:4665–4672.

44. Evans WK, Shepherd FA, Feld R, et al. VP-16 and cisplatin as first line therapy for small-cell lung cancer. J Clin Oncol. 1985;3:1471–1477.

45. Natale RB et al. S0124: a randomized phase III trial comparing irinotecan/cisplatin (IP) with etoposide/cisplatin (EP) in patients (pts) with previously untreated extensive stage small-cell lung cancer (E-SCLC) [Abstract 7512]. 2008 ASCO annual meeting.

46. Noda K, Nishiwaki Y, Kawahara M, et al. Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med. 2002;346:85–91.

47. Schmittel A, Sebastian M, Fischer von Weikersthal L, et al. For the Arbeitsgemeinschaft Internistische Onkologie thoracic oncology study group. A German multicenter, randomized phase III trial comparing irinotecan-carboplatin with etoposide-carboplatin as first-line therapy for extensive-disease small-cell lung cancer. Ann Oncol. 2011;22(8):1798–1804.

48. Okamoto H, Watanabe K, Nishiwaki Y, et al. Phase II study of area under the plasma-concentration-versus-time curve-based carboplatin plus standard-dose intravenous etoposide in elderly patients with small-cell lung cancer. J Clin Oncol. 1999;17:3540–3545.

49. Yamamoto, N., Tsurutani, J., Yoshimura, N., et al. Phase II study of weekly paclitaxel for relapsed and refractory small cell lung cancer. Anticancer Res,2006;26(1b):777–781.

50. Smyth JF, Smith IE, Sessa C, et al. Activity of docetaxel (Taxotere) in small cell lung cancer. Eur J Cancer 1994; 30A:1058–1060.

51. von Pawel J, Schiller JH, Shepherd FA, et al. Topotecan versus cyclophosphamide, doxorubicin, and vincristine for the treatment of recurrent small-cell lung cancer. J Clin Oncol. 1999;17(2):658–667.

52. Eckardt JR, von Pawel J, Pujol JL, et al. Phase III study of oral compared with intravenous topotecan as second-line therapy in small-cell lung cancer. J Clin Oncol. 2007;25:2086–2092.

53. O'Brien M, Ciuleanu TE, Tsekov H, et al. Phase III trial comparing supportive care alone with supportive care with oral topotecan in patients with relapsed small-cell lung cancer. J Clin Oncol. 2006;24:5441–5447.

54. Ardizzoni A, et al. Topotecan, a new active drug in the second-line treatment of small-cell lung cancer: a phase II study in patients with refractory and sensitive disease. The European Organization for Research and Treatment of Cancer Early Clinical Studies Group and New Drug Development Office, and the Lung Cancer Cooperative Group. J Clin Oncol. 1997;15:2090–2096.

55. Masuda N, Fukuoka M, Kusunoki Y, et al. CPT-11: a new derivative of camptothecin for the treatment of refractory or relapsed small-cell lung cancer. J Clin Oncol. 1992;10: 1225–1229.

56. Pietanza MC, Kadota K, Huberman K, et al. Phase II trial of temozolomide with relapsed sensitive or refractory small cell lung cancer, with assessment of methylguanine-DNA methyltransferase as a potential biomarker. Clin Cancer Res. 2012; 18:1138–1145.

57. Van der Lee I, Smit EF, van Putten JW, et al. Single-agent gemcitabine in patients with resistant small-cell lung cancer. Ann Oncol. 2001;12:557–561.

58. Masters GA, Declerck L, Blanke C, et al. Phase II trial of gemcitabine in refractory or relapsed small-cell lung cancer. J Clin Oncol. 2003;21:1550–1 555.

59. Cantwell BM, Bozzino JM, Corns P, et al. The multidrug resistant phenotype in clinical practice; evaluation of cross resistance to ifosfamide and mesna after VPI6-213, doxorubicin and vincristine (VPAV) for small cell lung cancer. Eur J Cancer Clin Oncol. 1988;24:123–129.

60. Jassem J, Karnicka-Mlodkowska H, van Pottelsberghe C, et al. Phase II study of vinorelbine (Navelbine) in previously treated small cell lung cancer patients. Eur J Cancer 1993; 29A: 1720–1722.

61. Furuse K, Kuboa K, Kawahara M, et al. Phase II study of vinorelbine in heavily previously treated small cell lung cancer. Oncology. 1996; 53:169–172.

62. Einhorn LH, Pennington K, McClean J. Phase II trial of daily oral VP-16 in refractory small cell lung cancer. Semin Oncol. 1990;17:32–35.

63. Johnson DH, Greco FA, Strupp J, et al. Prolonged administration of oral etoposide in patients with relapsed or refractory small-cell lung cancer: a phase II trial. J Clin Oncol. 1990; 8:1613–1617.

64. Postmus PE, Berendsen HH, van Zandwijk N, et al. Retreatment with the induction regimen in small cell lung cancer relapsing after an initial response to short term chemotherapy. Eur J Cancer Clin Oncol. 1987;23:1409–1411.

65. Giaccone G, Ferrati P, Donadio M, et al. Reinduction chemotherapy in small cell lung cancer. Eur J Cancer Clin Oncol. 1987;23:1697–1699.

(Revised 7/2014)

© 2014 Haymarket Media, Inc.


Lung Cancer Drug Monographs

Respiratory And Thoracic Cancers

Adriamycin Adriamycin Solution Alimta
Avastin Etopophos Gemzar
Hycamtin Hycamtin Capsules Iressa
Methotrexate for Injection Methotrexate Injection Mustargen
Navelbine Photofrin Tarceva
Taxol Taxotere Toposar
Trexall Vepesid Xalkori

Data provided by the Monthly Prescribing Reference (MPR) Hematology/Oncology Edition.
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