Used chemotherapy regimens in adjuvant or neoadjuvant situation in non-small cell lung cancer

1). Cisplatin 100 mg / m2 IV on day 1,

      Vinorelbine 30 mg / m2 IV day 1,8,15, 22

      Repeat in 28 days. 26% response rate.

       4 cycles

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2). Cisplatin 50 mg / m 2 IV on day 1 and 8

     Vinorelbine 25 mg / m2 iv day 1,8,15,22

   Repeat in 28 days. 26% response rate.

    4 cycles

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2). Cisplatin 75-80 mg mg / m 2 IV day 1

     Vinorelbine 25 mg / m2 IV day 1.8,

      Repeat in 21 days. 26% response rate.

         4 cycles

3). Cisplatin 80 mg / m 2 IV day 1.

Vinblastine 4 mg / m2 IV days 1,8,15, 22, 29 and then to 2 weeks

Repeat in 21 days. 4 cycles

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4). Cisplatin 100 mg / m2 / day IV on day 1

Etoposide 100 mg / m2 / day IV days 1-3

Repeat in 28 days. The response rate 14% -20%.

4 cycles

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In patients with comorbidities we will prefer

5). Paclitaxel 200 mg / m2 IV day 1 over 3 hours, followed by

     Carboplatin AUC 6 IVziua 1 1-2 hour infusion

Repeat in 21 days. 22% response rate.

Other acceptable regimens:

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6. Cisplatin 75 mg / m 2 IV day 1

   Gemcitabine 1250 mg / m 2 IV days 1, 8

   Repeat in 21 days. 31% response rate.

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7). Cisplatin 75 mg / m 2 IV day 1

      Docetaxel 75 mg / m2 IV on day 1.

       Repeat in 21 days

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In patients with adenocarcinoma or large cell carcinoma, or NSCLC NOS (without further specification)

7. Cisplatin 75 mg / m 2 IV day 1

    Pemetrexed 500 mg / m 2 IV on day 1.

     Repeat in 21 days

Chemotherapy regimens in stage IV NSCLC disease

I Line

Administer 4-6 cycles unless stated otherwise

Diets that include cisplatin-based doublet

Cisplatin 75 mg / m2 IV day 1

paclitaxel 175 mg / m2 IV day 1

Repeat in 21 days

Cisplatin 100 mg / m2 IV day 1

gemcitabine 1000 mg / m 2 IV days 1, 8, and 15

Repeat after 28 days

Cisplatin 60 mg / m2 IV day 1

gemcitabine 1000 mg / m2 IV on days 1 and 8

Repeat in 21 days

Cisplatin 75 mg / m2 IV day 1

docetaxel 75 mg / m2 IV day 1

repeat 21 days

Carboplatin AUC 6 IV day 1

paclitaxel 175-225 mg / m2 IV day 1

Repeat in 21 days

Carboplatin AUC 6 IV day 1

paclitaxel 90 mg / m2 IV on days 1, 8, and 15

Repeat after 28 days

carboplatin AUC 6 IV day 1

Protein bound paclitaxel 100 mg / m2 IV days 1,8 and 15

It repeats at 21 days

Carboplatin AUC 6 IV day 1

docetaxel 75 mg / m2 IV day 1

Repeat in 21 days

Carboplatin AUC 5 IV on day 1

gemcitabine 1250 mg / m 2 IV days 1, 8 and 21

repeat 21 days

Cisplatin 100 mg / m2 IV on day 1 is repeated after 28 days

vinorelbine 25 mg / m2 IV weekly

Cisplatin 40 mg / m2 IV day 1

vinorelbine 25 mg / m2 IV 1and 8 days

Repeat in 21 days

Carboplatin AUC 5 IV day 1

vinorelbine 30 mg / m2 IV on Day 1 and 8

Repeat in 21 days

Bevacizumab based chemotherapy in patients that meet the eligibility conditions (nonscuamoasa histology, brain metastases treated with no history of hemoptysis)

Carboplatin AUC 6 IV day 1

Paclitaxel 200 mg / m2 IV day 1

Bevacizumab 15 mg / kg IV on day 1

repeat in 21 days  (bevacizumab continue to finish 4-6 cycles! 21zile needles after chemotherapy until disease progression)

Cisplatin 80 mg / m2 IV day 1

gemcitabine 1250 mg / m2 IV on days 1 and 8

bevacizumab 7.5-15 mg / kg IV on day 1

Repeat in 21 days (bevacizumab continues to 4-6 cycles! 21zile after finishing chemotherapy until disease progression)

Docetaxel 75 mg / m2 IV day 1

Bevacizumab 15 mg / kg IV on day 1

Repeat 21 days until disease progression or for 52 weeks

Carboplatin AUC 6 IV day 1

pemetrexed 500 mg / m2 IV day 1

Bevacizumab 15 mg / kg IV on day 1

Repeat 21 days pemetrexed and bevacizumab until disease progression (vitamin B12 and dexamethasone for pemetrexed as premedication)

Pemetrexed-based chemotherapy in patients with histology nonscuamoasa

Cisplatin 75 mg / m2 IV day 1

pemetrexed 500 mg / m2 IV day 1

Repeat at 21d (vitamin B12 and dexamethasone for pemetrexed as premedication)

Carboplatin AUC 5 IV day 1

pemetrexed 500 mg / m2 IV day 1

It repeats at 21 days (vit B12 and dexamethasone for pemetrexed as premedication)

Chemotherapy in patients with EGFR positive immunohistochemistry

Cisplatin 80 mg / m2 IV day 1

vinorelbine 25 mg / m2 IV on days 1 and 8

Cetuximab 400 mg / m2 IV loading dose, furmata 250 mg / m2 IV weekly

Every repeats at 21 days (continue with weekly cetuximab after [4-6 cures until disease progression)

Treatment for patients with EGFR mutations:

 Erlotinib 150 mg PO daily until disease progression

Erlotinib is approved by FDA as first-line treatment in patients with EGFR mutations (deletion exon 19 or exon 21)

Afatinib 40 mg PO daily until disease progression

Afatinib is FDA approved as first-line treatment in patients with metastatic NSCLC with EGFR mutations (deletion exon 19 or exon 21)

Treatment for NSCLC patients with ALK-positive advanced or metastatic

X2 Crizotinib PO 250 mg / day to progression of the disease; interruption or dose reduction to 200 mg PO x 2 / day as tolerated

Crizotinib resistance or intolerance: Ceritinib 750 mg PO / day until disease progression (dose interruption or dose reduction may be necessary depending on tolerability)

Treatment of patients with contraindications to carboplatin or cisplatin

Gemcitabine 1100 mg / m 2 IV days 1 and 8

Docetaxel 100 mg / m2 IV on day 8

Repeat the 21zile

Gemcitabine 1000-1200 mg / m2 IV on day 1 and 8

Vinorelbine 25 to 30 mg / m2 IV on days 1 and 8

Repeat in 21 days

Nd line

It is administered until disease progression after first-line treat ment

Docetaxel 75 mg / m2 IV day 1

The repeat 21 days (4-6 cycles)

Pemetrexed 500 mg / m 2 IV day 1 (histology nonscuamoasa)

Repeat 21 days (4-6 cycles vitamin B12 and dexamethasone for pemetrexed as premedication)

150 mg PO daily erlotinib in patients with EGFR mutations or gene amplification until disease progression

Bevacizumab and erlotinib should not be given together.

Rd line

150 mg PO daily erlotinib in patients with EGFR mutations or gene amplification until disease progression

Erlotinib alone in the II and III of linier remains the standard of care

Prognosis:

1. Disease stage. Survival at 5 years for std. Pia -67%

stg. GDP -57% std. pIIB -39% stg. PIII – 23%. stg. cl. IIIB – 5%, stg. cl. IV – 1%.

2.Size of  tumor> 4 cm bad prognostic factor

3. Presence of node invasion – bad prognostic factor

4.Mucin – bad prognostic factor

5.Men and age> 60 years – bad prognostic factor

6. Performance Status: ECOG 0,1,2-good prognosis

ECOG 3.4 – poor prognosis

7. Weight loss> 5% by 6 months prior to diagnosis is a bad prognostic factor.

Molecular prognostic 8.Factori: C-myc overexpression of oncogenes, Kras, erb-B2 is associated with poor prognosis.

5-year survival for patients with NSCLC treated according to the stage is:

-67% Market stage,

-57% To the state GDP

Piia -55% for stage,

-39% For stage pIIB,

-23% For stage PIII,

-5% For stage cl. IIIB

-1% For stage cl. IV.

Tracking Local recurrences occur frequently in patients with bronchial stump, pleura, drainage hole or scar or recurrent mediastinal thoracotomy. Distant metastases most often occur in the brain, bone, liver and lung. It is recommended historically clinical examination, chest CT contrast ± 6-12 months during the first 2 years and then yearly chest CT without contrast. Tracking patients is recommended every 3 months during the first 2 years and 6 months to 3 years. We recommend smoking cessation, counseling, pharmacotherapy. Not recommended PET or MRI head.

Chemoprevention has not proven effective in patients with no risk (men smokers) nor in patients with lung cancer treated at the risk of developing cancer of lung II is 1-3% annually during the first 5 years.

Beta carotene and retinoids were assessed.