Tumour Group: LUNG Non-small cell lung cancer Adjuvant Vinorelbine PO* / Cisplatin 1 x x First line Vinorelbine IV / Cisplatin x First line Vinorelbine IV / Carboplatin x cisplatin Vinorelbine PO* / Cisplatin 1,2 x x First line Vinorelbine IV / Cisplatin x First line Vinorelbine IV / Carboplatin x cisplatin Gemcitabine / Cisplatin 3 x First line Gemcitabine / Carboplatin x gemcitabine / cisplatin for cisplatin Pemetrexed / Cisplatin ** x Pemetrexed / Carboplatin** x
Palliative Pemetrexed / Cisplatin x -6 Pemetrexed / Carboplatin x - 6 Vinorelbine PO* / Cisplatin 1,2 x -6 [60 mg/m 2 all cycles] x -6 First line excluding squamous cell carcinoma for cisplatin excluding squamous cell carcinoma First line. Gemcitabine / Cisplatin 3 x -6 (CPI version) First line. Gemcitabine / Carboplatin x - 6 (CPI version) gemcitabine / cisplatin Paclitaxel / Carboplatin 3 x -6 First line. Paclitaxel (weekly)- above for Carboplatin AUC2** specified patients Docetaxel/ Carboplatin x -6 First line. Vinorelbine 5 PO* single agent First line: unsuitable for x 6 platinum-based combination, especially elderly. Second line: patients progressing after first line taxane. Docetaxel 6 x 6 Second line. Erlotinib 7 1 st line (preferred) Erlotinib 7 2 nd,3 rd and th line CDF Gefitinib (funding programme) 1 st line alternative Pemetrexed IV single agent 2 nd line CDF Afatinib PO (named patient 2 nd -3 rd line (post chemo only) & TKI) EAP
Small cell lung cancer Primary Chemotherapy for Limited Stage Etoposide (IV D1, PO D2,3) /Cisplatin 8,16 x 6 Etoposide (IV D1, PO D2,3) /Carboplatin 8 x6 Etoposide (IV D1,2,3)/ Carboplatin x 6 First line Etop/Cis for Cisplatin First line in patients suitable for oral medication Palliative Chemotherapy Etoposide (IV D1; PO D2,3)/ Carboplatin 9,10,16 x 6 CAV 11 x 6 Topotecan x 6 Oral therapy First line for extensive stage. Second line therapy for limited or extensive stage. Second line therapy where CAV contraindicated Mesothelioma Pemetrexed/ Cisplatin 12 x 3 (CPI version) First line. Pemetrexed/ Carboplatin x 3 (CPI version) Palliative chemotherapy Pemetrexed/ Cisplatin 12 x 6 (CPI version) First line.
Pemetrexed/ Carboplatin x 6 Vinorelbine 1 PO* x 6 (CPI version) Unsuitable for platinum-based combination. Malignant thymoma Etoposide / Carboplatin 15 x First line. CAP First line Palliative chemotherapy Etoposide / Carboplatin 15 x First line. CAP First line * Across the Network PO vinorelbine is preferred to IV because of chemotherapy day unit capacity limitations, but at QEH and UHL the IV preparation continues to be used. References: 1. Rowinsky J Clin Oncol 12;175 2. Wozniak J Clin Oncol 16;259 3. Schiller New Engl J Med 36;92. Fossella J Clin Oncol 21;3016 5. Gridelli JNCI 91;66 6. Shepherd J Clin Oncol 18;2095 7. Shepherd New Engl J Med 353;123 8. Turrisi N Engl J Med 30:265 9. Skarlos Annals Oncol 5;601 10. Sundstrom J Clin Oncol 20:665 11. Von Pawel J Clin Oncol 17;658 12. Vogelzang J Clin Oncol 21;2636 13. Byrne J Clin Oncol 17;25 1. Steel J Clin Oncol 18;3912 15. Giaccone J Clin Oncol 1;81 16. Annals Oncol 5;601
Tumour Group: LUNG Chemotherapy regimens agreed by: Dr Shahreen Ahmad, Consultant Clinical Oncologist Dr Rohit Lal, Consultant Medical Oncologist Dr David Landau, Consultant Clinical Oncologist Dr Ana Montes, Consultant Medical Oncologist 12.10.2012 Dr Eleni Karapangiotu, Consultant Medical Oncologist Dr James Spicer, Consultant Medical Oncologist Dr Ana Montes Chair of Drugs Expenditure Executive, Dr Janine Mansi Chair of Drugs and Therapeutics Advisory Committee, 22 nd