Chemotherapy to Treat Non-Small Cell Lung Carcinoma

Gemcitabine hydrochloride (Gemzar) is a chemotherapeutic drug that has unique activity against many solid tumors, including non-small cell lung cancer (NSCLC). Combination therapy with gemcitabine, cisplatin (Platinol), and vinorelbine tartrate (Navelbine) has been found to be safe and very active in persons with advanced non-small cell lung cancer (NSCLC). Tumors in these patients often cannot be removed by surgery (are unresectable), and so the patient may not survive for even 1 year without therapy.

OPTION 1: Combination chemotherapy with gemcitabine (Gemzar), cisplatin (Platinol), and vinorelbine tartrate (Navelbine)

The toxic side effects of combination chemotherapy are manageable in most patients. Side effects include neutropenia (reduced number of granular white blood cells) and thrombocytopenia (reduced number of blood-clotting platelets).

Another treatment option for NSCLC patients with advanced disease is alternating chemo-radiotherapy (e.g., cisplatin and etoposide, followed by radiotherapy):

OPTION 2: Combination chemotherapy with etoposide (VP-16, VePesid) and cisplatin (Platinol), also called "EC" followed by 60 Gy chest radiation therapy plus surgical resection of tumor or pneumonectomy (lung removal) in cases of operable tumor

The toxic side effects of this program are leukopenia (reduced number of white blood cells) and vomiting.

About Chemotherapy for NSCLC

Chemotherapeutic programs alone have limited activity against non-small cell lung cancer; however, new "protective" drugs, cytotoxic (cell-killing) agents, and radiotherapy techniques—either alone or in combination—are promising.

For example, cell-protecting compounds are being tested for their defense of normal tissue against the toxic effects of chemotherapy and radiotherapy. These, or similar medication(s), may permit physicians to use higher doses of chemotherapeutic agents (e.g., cisplatin, carboplatin, paclitaxel), thereby improving therapeutic results, prognosis, and survival.

In July 2015, the U.S. Food and Drug Administration (FDA) approved gefitinib (Iressa) as a first-line treatment for patients with metastatic NSCLC characterized by specific epidermal growth factor receptor (EGFR) gene mutations. The specific mutations are found in about 10 percent of non-small cell lung cancers. Gefitinib is a kinase inhibitor that helps prevent the development of cancer cells when certain EGFR mutations are present.

Research shows that Iressa shrinks tumors in about 50 percent of patients, and the effects last approximately 6 months. Common side effects include diarrhea and skin reactions (e.g., rash, dry skin, itching, acne). Serious side effects include interstitial lung disease, liver damage, eye problems, and severe gastrointestinal tract issues.

Updated by Remedy Health Media

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 14 Aug 1999

Last Modified: 24 Sep 2015