What are the chemotherapy options for lung cancer

It is currently believed that tumors are not a single local disease. Most tumors are already systemic diseases when diagnosed, and potential metastases already exist before treatment. The improvement in tumor treatment results is largely due to the combined use of surgery, radiotherapy, chemotherapy and other treatment methods.

1. S-1 combined with cisplatin chemotherapy.

Randomly give S-1 + cisplatin (80mg/m2/d or 40mg/m2bid, d1, d21 + 60mg/m2, q5w) or docetaxel + cisplatin (60mg/m2, d1 + 80mg/m2, d1, q3w). The primary endpoint was survival (OS). There was no significant difference in median survival time (16.1m vs 17.1m) and median PFS (4.9m vs 5.2m) between the S-1 + cisplatin group and the docetaxel + cisplatin group. The tolerability of the S-1 plus cisplatin group was better than that of the docetaxel plus cisplatin group. According to questionnaire analysis, the quality of life of the SP group was also better than that of the latter.

2. Pemetrexed combined with carboplatin significantly improves the survival rate.

A randomized phase III study comparing pemetrexed alone with pemetrexed plus carboplatin in the treatment of advanced non-small cell lung cancer and PS2. This study included 205 patients with advanced non-small cell lung cancer with PS2. The median age was 65 years. The survival time was significantly prolonged and the response rate was significantly improved. Based on the obvious benefits of the combination therapy, the protocol group revised the guidelines as soon as possible and applied them clinically.

3. First-line chemotherapy and alternating with erlotinib

All patients were treated with gemcitabine combined with cisplatin or carboplatin. There was a significant difference between the erlotinib group and the placebo group. Among patients with objective response, the median duration of response in the erlotinib group was significantly longer than that in the placebo group. The rapid response model can provide new ideas for the treatment of epidermal growth factor receptor mutations and unknown epidermal growth factor receptor status in non-small cell lung cancer.

4. Patients with advanced non-small cell lung cancer who are not suitable for chemotherapy

Erlotinib prolonged survival, but only in patients who developed an erlotinib rash within 28 days of treatment.

5. Afatinib

In particular, in patients with the most common EGFR mutation, the progression-free survival rate was almost double that of chemotherapy.

6. The safety of bevacizumab in patients with CNS metastases is acceptable.

The study showed that patients achieved the pre-defined primary endpoint of PFS within 6 months, with similar response rates for primary tumors, brain metastases, and other metastases, and a low incidence of intracranial hemorrhage.

Surgery and radiotherapy are local treatments, while chemotherapy is a systemic treatment. If used reasonably at a specific stage, it can kill or control primary tumor lesions, inhibit systemic metastatic lesions, and reduce recurrence and metastasis.

The main treatment for stage I to IIIA non-small cell lung cancer (NSCLC) is surgery. Chemotherapy is generally used as postoperative adjuvant therapy, and can also be used as preoperative neoadjuvant chemotherapy for stage IIIA patients.

Patients in stage I and V are mainly treated with chemotherapy, and local palliative radiotherapy can be performed. Although there are many effective chemotherapy regimens for non-small cell lung cancer (NSCLC), the overall efficacy is not as good as that for small cell lung cancer (SCLC). The effective rate is generally around 30%. There are reports that increasing the dose can increase the intensity to around 50%, but most of them require hematopoietic stimulating factor treatment.

Few patients with non-small cell lung cancer (NSCLC) can achieve complete remission through chemotherapy, so most of them cannot be cured by chemotherapy. They need to be combined with other treatment methods such as surgery or radiotherapy.

In the limited stage of small cell lung cancer (SCLC), the survival rate can be improved through combined treatment of radiotherapy, chemotherapy and surgery, while in the extensive stage, chemotherapy is the main treatment and the prognosis is very poor.