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Chapter 085. Neoplasms of the Lung (Part 16)

Chemotherapy Chemotherapy palliates symptoms, improves the quality of life, and improves survival in newly diagnosed patients with stage IV NSCLC, particularly in patients with good performance status. Whereas the median survival for untreated patients is roughly 4–6 months, and 1-year survival is 5–10%, with combination chemotherapy the median survival is 8–10 months, 1-year survival is 30–35%, and 2-year survival 10–15%. Combination chemotherapy produces an objective tumor response in 20–30% of patients, although the response is complete in . | Chapter 085. Neoplasms of the Lung Part 16 Chemotherapy Chemotherapy palliates symptoms improves the quality of life and improves survival in newly diagnosed patients with stage IV NSCLC particularly in patients with good performance status. Whereas the median survival for untreated patients is roughly 4-6 months and 1-year survival is 5-10 with combination chemotherapy the median survival is 8-10 months 1-year survival is 30-35 and 2-year survival 10-15 . Combination chemotherapy produces an objective tumor response in 20-30 of patients although the response is complete in 5 . In addition economic analysis has found chemotherapy to be costeffective palliation for stage IV NSCLC. However the use of chemotherapy for NSCLC requires clinical experience and careful judgment to balance potential benefits and toxicities for these patients. Chemotherapy for previously untreated good-performance-status patients typically consists of two drugs doublets . Traditionally one of the two drugs has been either cisplatin or carboplatin and the other drug is a taxane paclitaxel or docetaxel gemcitabine or a vinca alkaloid such as vinorelbine. No major difference in outcome has been observed between the standard chemotherapy doublets although they differ in terms of schedule side effects and cost. Cytotoxic chemotherapy for first-line chemotherapy is typically administered for four to six cycles no benefit has been shown for continuing the same chemotherapy beyond that point. After four to six cycles chemotherapy is usually stopped and the patient observed closely for tumor progression at which point second-line chemotherapy may be started if the patient s performance status remains good. Nausea with typical first-line regimens is usually mild particularly when 5-HT3 serotonin antagonists are used as antiemetics. Hair loss depends on the choice of regimen and should be discussed with the patient. All regimens cause myelosuppression but the incidence of neutropenic fevers bleeding .