Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) are the two main pathological types of lung cancer, and they respond differently to treatment and drugs, so treatment principles differ and chemotherapy regimens differ. Your doctor will choose based on your tumor pathology type, tolerance level, and personal preference.
Related reading:
Here is a list of common chemotherapy regimens for NSCLC and SCLC.
I. NSCLC
1. Advanced NSCLC
For advanced NSCLC without driver gene (EGFR, ALK, etc.) mutations, the first-line standard of care remains chemotherapy, with platinum-containing (cisplatin or carboplatin) regimens preferred.
Among them, pemetrexed+platinum±bevacizumab or paclitaxel+platinum+bevacizumab is preferred for adenocarcinoma;
Squamous carcinoma is preferable to gemcitabine or paclitaxel + platinum.
Let’s look specifically:
1) First-line regimen
If the performance status score (PS) is 0 or 1, the classic regimen for first-line chemotherapy is a platinum-containing two-drug regimen: gemcitabine/docetaxel/paclitaxel/vincristine/pemetrexed (nonsquamous) + cisplatin/carboplatin (class 1 evidence), also in combination with bevacizumab (class 2A evidence). The PCB regimen is also available: paclitaxel + carboplatin + bevacizumab (class 1 evidence).
Note: “Level of evidence” indicates the strength of the evidence supporting this recommendation. The first category of evidence is that there is sufficient research evidence and expert consensus (1A) or only minor controversy (1B).
If disease control is achieved with pemetrexed + platinum and treatment with the PCB regimen, maintenance therapy with pemetrexed or bevacizumab may be an option.
If PS is a score of 2, the basic chemotherapy strategy is a single agent regimen with platinum removed.
The following first-line chemotherapy regimens are commonly used in the clinic for NSCLC:
| Table 1. Common first-line chemotherapy regimens for non-small cell lung cancer | ||||
| PS score | Protocol name | Chemotherapy regimen | Duration of drug administration | Time and period |
|
PS=0~1 |
NP scheme |
Rabin Changchun |
Day 1,8 |
21-day cycle, typically 4-6 cycles |
|
Cisplatin or carboplatin |
Day 1 |
|||
|
GP Program |
Gemcitabine |
Day 1,8 |
||
|
Cisplatin or carboplatin |
Day 1 |
|||
|
DP Program |
Docetaxel |
Day 1 | ||
|
Cisplatin or carboplatin |
Day 1 | |||
|
AP Program |
Pemetrexed |
Day 1 | ||
|
Cisplatin or carboplatin |
Day 1 | |||
|
PCB Solutions |
Paclitaxel + carboplatin + bevacizumab |
Day 1 | ||
|
Single-drug regimen with platinum removed |
Gicitabine/docetaxel/paclitaxel/vincristine/pemetrexed (non-squamous) |
as before |
||
Note: Bevacizumab in combination with gemcitabine/docetaxel/paclitaxel/vincristine/pemetrexed (non-squamous) + cisplatin/carboplatin are administered for the first day and are generally maintained.
2) Second-line regimens
It is an alternative regimen after failure of first-line chemotherapy. There are not many options, and a single-agent regimen of docetaxel and pemetrexed can be used, provided it was not used in first line.
The following second-line chemotherapy regimens are commonly used clinically for NSCLC:
| Table 2. Common second-line chemotherapy regimens for non-small cell lung cancer | ||
| Duration of dosing | Time and period | |
| Docetaxel | Day 1 | 21 days for 1 cycle |
| Pemetrexed | Day 1 | 21 days for 1 cycle |
2.
2. Chemotherapy regimens for inoperable, locally advanced (IIIA/IIIB) NSCLC
The recommended combination is radiotherapy, with concurrent or sequential chemoradiotherapy depending on the circumstances.
Among the chemotherapy options are cisplatin + etoposide; cisplatin + paclitaxel/docetaxel/ pemetrexed/vincristine. The physician often weighs multiple options when developing the specific regimen.
Related reading:
3. Adjuvant chemotherapy regimen for completely resected stage IIA~IIIA NSCLC
Also a two-drug platinum-containing regimen as described in “Article 2,” with 3 to 4 weeks of postoperative adjuvant chemotherapy.
4.
4. Neoadjuvant chemotherapy for resectable stage IIIA NSCLC
A short course of preoperative neoadjuvant chemotherapy for 2 to 3 weeks, also on a platinum-containing two-drug regimen as described in “Article 2,” with surgery generally occurring 2 to 4 weeks after the end of chemotherapy.
II. SCLC
1. limited-stage SCLC
A combination of chemotherapy, surgery, and radiotherapy is recommended.
If early staged (T1-2N0), surgery followed by EP (etoposide + cisplatin/carboplatin) regimen with adjuvant chemotherapy or radiotherapy;
If surgery is not possible (beyond T1-2N0), the standard treatment regimen is concurrent radiotherapy.
2. Extensive stage SCLC
There is generally a combination of chemotherapy-based treatment.
The EP regimen is the classic regimen for first-line treatment, and physicians sometimes choose the irinotecan + cisplatin/carboplatin regimen. Patients who relapse or progress within 6 months of first-line chemotherapy may be treated with second-line chemotherapy with topotecan or enrolled in a clinical trial.
If disease progression occurs beyond 6 months, the initial regimen may be chosen again.
The following first-line chemotherapy regimens are commonly used in the clinic for SCLC:
| Table 3. Common first-line chemotherapy regimens for small cell lung cancer | ||
| chemotherapy regimens |
Duration of drug administration (days) |
Timing and periodicity |
|
EP: etoposide cisplatin |
1~3 1 |
21 days for one cycle, 4 to 6 cycles |
|
EC: Etoposide Carboplatin |
1 to 3 1 |
21 days for one cycle, 4 to 6 cycles |
|
IP: Irinotecan cisplatin |
1,8,15 1 |
28 days for one cycle, 4 to 6 cycles |
|
IP: Irinotecan cisplatin |
1,8 1,8 |
21 day cycle, 4 to 6 cycles |
|
IC: Irinotecan Carboplatin |
1,8,15 1 |
28 days for one cycle, 4 to 6 cycles |
Commonly used second-line chemotherapy regimens for SCLC are shown in the following table:
Table 4, Commonly used second-line chemotherapy regimens for small cell lung cancer
| Chemotherapy regimen | Duration of medication | Time and period |
|
Topotecan static point Oral |
1~5 1~5 |
21 days for one cycle |
Extended reading:
I. What is first-line chemotherapy?
For patients with non-curable, locally advanced or advanced stage IIIB/IV NSCLC, or for patients with extensive stage SCLC, the first standard of care recommended by physicians is first-line chemotherapy. For patients treated with surgery, adjuvant chemotherapy is also first-line therapy if relapse occurs within 6 months of the end of chemotherapy.
Notably, for patients treated with radical surgery, preoperative neoadjuvant therapy, postoperative adjuvant therapy (recurrence beyond 6 months), and concurrent radiotherapy are not considered first-line chemotherapy.
II. What is second-line chemotherapy?
Patients with NSCLC or SCLC who have failed first-line chemotherapy and have been advised by their doctor to change their treatment regimen are treated with second-line chemotherapy. There is also a situation where the disease is stable after first-line therapy, but after a period of time, the disease progresses, and the regimen that the doctor recommends to change is also second-line chemotherapy.
Co-authors: Dr. Yue-Li Sun, Guangdong Provincial People’s Hospital, Guangdong Lung Cancer Institute Dr. Xiaoxiao Peng Dr. Ming-Feng Zhang