Treatment Therapies
The four primary treatment modalities used in the management of patients with NSCLC are:1
- Surgery
- Radiation therapy
- Combination chemotherapy
- Targeted therapy
Surgery
Historically, surgical resection of small, localized tumours has provided the best chance for cure in patients with early-stage NSCLC. Surgical resection is usually possible in Stage I or II NSCLC and is possible for some patients with Stage IIIA NSCLC. If there is clinically evident nodal involvement (N2), surgery alone is not a curative option.1,2
Patients with advanced NSCLC (Stages IIIB and IV) have extensive invasion of local tissues (T4) or extensive nodal involvement (N3) and are considered inoperable. However, surgical resection of the primary tumour, in addition to radiation and/or chemotherapy, may be considered in some patients with advanced NSCLC to help ease tumour burden and relieve symptoms, offering improved quality of life and the potential for improved survival. 1,2
Radiation therapy
Radiation therapy is used for the management of NSCLC in four major ways:1-3 Primary therapy in early-stage disease in patients with medical contraindications to surgery such as poor performance status. Adjuvant therapy following surgery to achieve better local control. Primary therapy for unresectable disease, used with or without chemotherapy. Palliative therapy for the control of symptoms in Stage IIIB and Stage IV disease.
Combination chemotherapy
Chemotherapy can be used in all stages of NSCLC from early to advanced, but as a single modality, it is rarely curative in lung cancer patients. In early-stage NSCLC (Stage I or II), chemotherapy can be used in addition to surgery or radiation therapy as an attempt to cure the disease. Cisplatin/taxane-based combinations are used most often in first-line therapy, though some nonplatinum agents have proven to be effective. In advanced NSCLC (Stage IIIB or IV), single-agent chemotherapy is also used as a primary treatment modality. Treatment of late-stage NSCLC with chemotherapy is not considered curative but is intended to relieve symptoms and extend survival.2
Targeted therapy
Although platinum- and taxane-based chemotherapy regimens have been able to increase survival in patients with advanced NSCLC, the side effects of all chemotherapeutic agents—used alone or in combination—can be significant.1
Intensive research has led to new molecular and genetic understanding of cancer biology. Researchers are beginning to develop therapeutic agents that are able to target and kill cancer cells while sparing healthy cells. Targeted therapies offer the possibility of effective treatment with minimal side effects.1
The development, growth and spread of cancer are regulated by specific cell surface receptors and molecular mediators. These receptors and growth-promoting molecules can be specifically targeted by new therapies. Such therapies have the potential to significantly improve survival rates without causing some of the major side effects of chemotherapy such as myelosuppression, neutropenia and neuropathy. 4,5
Currently, the only targeted therapy approved for use in NSCLC is a HER1/EGFR tyrosine kinase inhibitor, erlotinib.5 The human epidermal growth factor receptor (HER) family of tyrosine kinase (TK) receptors are a group of four closely related receptors (HER1/EGFR, HER2, HER3, HER4) that play a central role in cell division and cell death.6
References:
1. Putnam JB, Fossella FV, Komaki R, eds. Implementation of multidisciplinary care in the treatment of patients with lung cancer. In: Fossella FV, Komaki R, Putnam JB, eds. Lung Cancer. New York, NY: Springer-Verlag; 2003:1-24.
2. Schrump DS, Altorki NK, Henschke CL, Carter D, Turrisi AT, Gutierrez ME. Non-small cell lung cancer. In: DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:745-843.
3. National Cancer Institute. Non-small cell lung cancer (PDQ®): treatment. National Institutes of Health; 2004. Available at: www.nci.nih.gov treatment/non-small-cell-lung/healthprofessional. Accessed June 2008.
4. Kim TE, Murren JR. Therapy for stage IIIB and stage IV non-small cell lung cancer. Clin Chest Med. 2002;23:209-224.
5. Tarceva (erlotinib) summary of product characteristics, F. Hoffmann-La Roche Ltd., 2007.
6. Baselga J. Why the epidermal growth factor receptor? The rationale for cancer therapy. Oncologist. 2002;7(suppl 4):2-8.
