Lung cancer can be divided into two categories based on histopathology: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
Chemotherapy for lung cancer includes radical chemotherapy (for a small number of patients with SCLC), palliative chemotherapy, chemotherapy in combination with radiation therapy, adjuvant chemotherapy, and neoadjuvant chemotherapy. So how do your doctors “tailor” your chemotherapy regimen from the thousands of options available to you?
Usually, your doctor chooses a chemotherapy regimen based on the tumor itself, i.e., NSCLC or SCLC, and then considers your performance status (PS), your organ function, your financial situation, and the toxic effects of the chemotherapy drugs to develop a different chemotherapy regimen.
Physician Considerations: Drug Toxicity
Toxic side effects of drugs are a point that physicians must consider when choosing a chemotherapy regimen.
In terms of platinum, cisplatin and carboplatin are both very classical drugs with little difference in overall efficacy, but with different toxicities. The gastrointestinal side effects (nausea, vomiting, diarrhea) and nephrotoxicity are more pronounced with cisplatin, whereas the myelosuppressive effects (lowered white blood cells, lowered platelets) are more severe with carboplatin.
The main side effects of paclitaxel analogs are allergic reactions and peripheral neuritis.
Vincristine, gemcitabine, and docetaxel all have stronger myelosuppressive effects, but gemcitabine mainly reduces platelets significantly, and docetaxel mainly reduces neutrophils.
Myelosuppression as well as gastrointestinal reactions were less with pemetrexed.
Bevacizumab may cause hypertension and proteinuria. Doctors often try to avoid chemotherapy regimens with similar side effects, especially if the patient already has some organ insufficiency or has abnormalities in the relevant tests.
Physician Considerations: Patient Activity Status
PS describes the patient’s physical strength, a score that physicians use to understand the patient’s general health and ability to tolerate treatment. A score from 0 to 5 represents good to poor tolerance of treatment.
Usually, when the PS score is 0 or 1, physicians can choose a platinum-containing two-drug regimen with some confidence; however, when the PS score is 2 or higher, it may be prudent to choose a platinum-free single-agent chemotherapy regimen.
Physician consideration: affordability
In fact, when choosing a chemotherapy regimen, physicians often take into account the patient’s affordability in addition to the condition. For example, the price difference between domestic and imported drugs for the same pemetrexed is significant, and lack of affordability may limit the freedom of choice.
In addition, medical conditions and drug “accessibility” vary by region, and if a drug is not available at a hospital in a particular region, this may also affect the choice of options.
Co-authors: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Dr. Sun Yueli Dr. Zhang Mingfeng