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  • imageLung cancer is the leading cause of cancer deaths in both men and women in the United States. The overall 5-year survival rate for all types of lung cancer is about 18%.

  • imageCigarette smoking is responsible for most lung cancers. Smoking cessation should be encouraged, particularly in those receiving curative treatment (ie, Stages I to IIIA nonsmall cell lung cancer [NSCLC] and limited-stage small cell lung cancer [SCLC]).

  • imageNSCLC is the most commonly diagnosed type of lung cancer (about 80%). NSCLC typically has a slower growth rate and doubling time than SCLC.

  • imageAnnual screening with low-dose computed tomography (LDCT) imaging is currently recommended to identify lung cancer in high-risk individuals. However, ongoing studies are evaluating the optimal frequency and duration, and the effects of false-positive tests.

  • imageTreatment decisions for NSCLC are guided by the stage of disease, histology (squamous or nonsquamous), and molecular features (PD-L1, EGFR, ALK, BRAF, NTRK, and ROS1) of the tumor. Patient-specific factors (eg, performance status, comorbid conditions) must also be considered when developing a treatment plan.

  • imageThe treatment goals for SCLC lung cancer are cure (early-stage disease), prolonged survival, and maintenance of or improved quality of life through alleviation of symptoms.

  • imageEarly-stage lung cancer has the highest cure rates, following surgical resection of the tumor with or without chemotherapy for NSCLC and chemoradiotherapy for SCLC.

  • imageImmunotherapy with anti-programmed-death 1 (PD-1) targeting monoclonal antibody is recommended as first-line treatment of metastatic NSCLC that is PD-L1 positive. Immunotherapy can be added to a platinum doublet in patients with tumors that do not have a targetable genetic mutation and are PD-L1 negative. Patients with extensive-stage SCLC may receive immunotherapy either with a platinum doublet as first-line therapy or alone as second-line therapy.

  • imageTargeted therapies for advanced-stage NSCLC are preferred over platinum-based doublets or immunotherapy as first-line therapy in patients whose tumors harbor targetable genetic mutations such as EGFR exon 19 deletions or exon 21 (L858R) substitution mutations, or mutations in ALK, BRAF, NTRK, or ROS1.

  • imageOptimal patient care includes the management of adverse events from drug therapy. Adverse events may cause delays in treatment administration, increase morbidity, and contribute to treatment failure.


Patient Care Process for Lung Cancer



  • Patient characteristics (eg, age, gender, ancestry)

  • Patient history (past medical, family, social—dietary habits, tobacco use)

  • Current medications and any prior anticancer therapy

  • Symptoms of pain, pain score, pain management

  • Clinical and objective evaluation of tumor status

  • Objective data

    • BP, heart rate (HR), height, weight, respiratory rate

    • Labs (eg, serum electrolytes, complete blood count, Scr, BUN)

    • Imaging scans (CT scan, endobrachial ultrasound)

    • Biopsy to obtain histology (NSCLC or SCLC, squamous or nonsquamous [Table 146-1])

    • Tumor expressed biomarkers (PD-1, EGFR, ALK, ROS1, BRAFV600E, NTRK)


  • Type of and response to any prior treatments

  • Stage of tumor (Table 146-2)

  • Drug therapy options based on the cancer’s histology, stage, and presence/absence of biomarkers

  • Need for any dose ...

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