- Lung 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 15%.
- Cigarette smoking is responsible for most lung cancers. Smoking cessation should be encouraged, particularly in those receiving curative treatment (i.e., stages I to IIIA non–small cell lung cancer [NSCLC] and limited-stage small cell lung cancer [SCLC]).
- NSCLC is diagnosed in most (˜80%) lung cancer patients. NSCLC typically has a slower growth rate and doubling time than SCLC.
- Screening test is currently recommended to identify lung cancer in high-risk individuals. However, several studies are evaluating the optimal frequency and duration, as well as the impact of false-positive tests.
- Treatment decisions are guided by the stage of disease, which is characterized by tumor size and spread. Patient-specific factors (i.e., performance status, comorbid conditions, etc.) must also be considered when developing a treatment plan.
- The treatment goals in lung cancer are cure (early stage disease), prolongation of survival, and maintenance or improvement of quality of life through alleviation of symptoms.
- Early stage lung cancer has the highest cure rates when surgical resection of the tumor is used with or without chemotherapy for NSCLC and chemoradiotherapy for SCLC.
- Advanced-stage lung cancer is primarily treated with systemic therapy. Doublet chemotherapy regimens are superior in response to single-agent regimens and should be used when the patient can tolerate the associated toxicity. Platinum-containing doublets are first-line treatment in most cases of NSCLC and SCLC.
- Optimal patient care needs to include prevention and treatment of adverse events from chemotherapy. Adverse events may cause delays in chemotherapy administration, increase morbidity, and contribute to treatment failure.
On completion of the chapter, the reader will be able to:
Explain the importance of lung cancer mortality relative to other cancers.
Describe the relationship between cigarette smoking and lung cancer.
List the most prevalent cell types of carcinomas in the lung.
Contrast the frequency of nonsmall cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
Briefly describe lung cancer screening and the resulting benefits and risks.
Contrast the role of surgery for stage I/II and stage IV NSCLC.
Describe the role of radiotherapy for stage I/II NSCLC.
List the potential treatment regimens for locally advanced NSCLC stages IIB, IIIA, and IIIB.
List the prognostic factors for survival in stage IV NSCLC patients.
Choose a chemotherapy regimen for the initial treatment of stage IV NSCLC in those with favorable prognostic factors.
Describe patients who with NSCLC will benefit from maintenance therapy and which agents are appropriate.
Explain which patient population is most likely to respond to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors.
Describe the adverse effects seen with bevacizumab.
Select an appropriate induction chemotherapy regimen for limited- and extensive-disease SCLC.
List the alternative induction chemotherapy regimens for extensive-disease SCLC.
Describe the role of radiotherapy in SCLC.
Lung cancer is a major cause of morbidity and mortality. It ...