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UPDATE SUMMARY

Update Summary

The following updates were made on February 4, 2021:

  • Nonsmall Cell Lung Cancer, Local Disease (Stages I-II): revised chemotherapy options and added osimertinib for EGFR+ disease

  • Nonsmall Cell Lung Cancer, Advanced (Stage IV) Disease and Relapsed Disease: added atezolizumab as option to PD-L1+ tumor section; added therapy options for MET and RET mutations in Targetable Genetic Mutation section

  • Small Cell Lung Cancer Table 146-6 and Extensive Disease section: added information about chemotherapy + durvalumab and lurbinectedin to table and text and updated second-line options for extensive disease

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 62, Lung Cancer.

KEY CONCEPTS

KEY CONCEPTS

  • 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.

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