Primary lung cancer (hereinafter referred to as lung cancer) is one of the most common malignant tumors in China. 2010 Health Statistical Yearbook shows that in 2005, lung cancer mortality accounted for the 1st place of malignant tumor mortality in China. Lung cancer is divided into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC)
Drug therapy for non-small cell lung cancer includes chemotherapy and molecular targeted drug therapy (EGFR-TKI therapy). Chemotherapy is divided into palliative chemotherapy, adjuvant chemotherapy and neoadjuvant chemotherapy, which should be strictly controlled for clinical indications and administered under the guidance of medical oncologists. Chemotherapy should be administered under the guidance of medical oncologists. Chemotherapy should take into full consideration the patient’s disease stage, physical condition, adverse effects, quality of life and patient’s wishes to avoid over-treatment or under-treatment. The efficacy of chemotherapy should be evaluated in a timely manner, and adverse reactions should be closely monitored and prevented, and the drugs and/or doses should be adjusted as appropriate.
1.Pharmacological treatment of advanced NSCLC.
(1) First-line drug therapy. The platinum-containing two-drug regimen is the standard first-line treatment; for patients with EGFR mutation, targeted drug therapy is available; for those who are eligible, anti-tumor vascular drugs can be combined with chemotherapy. For patients who achieve disease control (CR+PR+SD) with first-line therapy, maintenance therapy can be selected if available.
(2) Second-line drug therapy. The second-line treatment options include doxorubicin, pemetrexed, and targeted EGFR-TKI.
(3) Third-line drug therapy. EGFR-TKI can be selected or entered into clinical trials.
(2) Drug therapy for NSCLC that cannot be surgically resected.
Combination of radiotherapy and chemotherapy is recommended, and synchronous or sequential radiotherapy and chemotherapy can be chosen according to the specific situation. The recommended chemotherapeutic agents for synchronous treatment are pegylated glycosides/cisplatin or carboplatin (EP/EC) with paclitaxel or doxorubicin/platinum. Sequential therapy chemotherapeutic agents are shown in first-line therapy.
3. Perioperative adjuvant therapy for NSCLC.
For completely resected stage II-III NSCLC, 3-4 cycles of postoperative adjuvant chemotherapy with a platinum-containing two-drug regimen are recommended. Adjuvant chemotherapy begins when the patient’s postoperative physical status is basically normalized and is usually started 3-4 weeks after surgery.
Postoperative adjuvant chemotherapy is not routinely recommended for patients with completely resected stage IB.
Neoadjuvant chemotherapy: Two platinum-containing drugs and 2 cycles of preoperative neoadjuvant chemotherapy can be chosen for resectable stage III NSCLC. Efficacy should be evaluated promptly and attention should be paid to determine adverse effects to avoid additional surgical complications. Surgery is usually performed 2-4 weeks after the end of chemotherapy. Postoperative adjuvant therapy should be based on preoperative staging and the efficacy of neoadjuvant chemotherapy, and the original regimen should be continued or adjusted as appropriate according to patient tolerance if it is effective, while the regimen should be changed if it is not effective.
Appendix: Principles of chemotherapy for non-small cell lung cancer.
(1) Patients with lung cancer with KPS <60 or ECOG >2 should not be treated with chemotherapy.
(2) Lung cancer patients with white blood cells less than 3.0×109/L, neutrophils less than 1.5×109/L, platelets less than 6×1010/L, red blood cells less than 2×1012/L, and hemoglobin less than 8.0g/dl should not be treated with chemotherapy in principle.
(3) Lung cancer patients with abnormal liver and kidney functions, laboratory indexes exceeding twice the normal value, or those with serious complications and infections, fever and bleeding tendency should not be treated with chemotherapy.
(4) Discontinuation or change of regimen should be considered if the following conditions occur in chemotherapy.
If the lesion progresses after 2 cycles of treatment or deteriorates again during the rest period of the chemotherapy cycle, the original regimen should be discontinued and other regimens should be used as appropriate; if the adverse reaction of chemotherapy reaches grade 3-4 and poses a significant threat to the patient’s life, the drug should be discontinued and other regimens should be used for the next treatment; if serious complications occur, the drug should be discontinued and other regimens should be used for the next treatment.
(5) The standardization and individualization of treatment regimens must be emphasized. The basic requirements of chemotherapy must be mastered. In addition to the routine application of antiemetic drugs, platinum drugs other than carboplatin require hydration and diuresis. Routine blood tests are performed twice a week after chemotherapy.
(6) The efficacy evaluation of chemotherapy should refer to the WHO criteria for evaluating the efficacy of solid tumors or the RECIST criteria for evaluating the efficacy of chemotherapy.