What is chemotherapy for lung cancer. Treatment of lung cancer: directions, tactics, schemes. How long do such patients live?

In treatment regimens for stage 1-2 lung cancer, chemotherapy is most often used in combination with other methods: surgery, radiation therapy, targeted therapy and immunotherapy.

Small cell cancer light is better amenable to chemotherapy than non-small cell.

A course of chemotherapy treatment may be preceded by:

  • surgical operation;
  • destruction of the tumor focus using the CyberKnife or TomoTherapy installation;
  • other types of radiation treatment.

In this case, we talk about neoadjuvant therapy, the goal of which is to reduce the size of the tumor and the manifestations of the disease to alleviate the tasks facing surgeons or radiotherapists.

After surgical or radiation treatment, cytostatics are prescribed to destroy cancer cells that may remain in the body.

Oncologists often choose chemotherapy as the main treatment method for stages 3 and 4 lung cancer. Treatment in this case may be:

  • radical - aimed at destroying the tumor or inhibiting its growth with the patient going into stable remission;
  • palliative - aimed at reducing the manifestations of the disease and improving the patient’s quality of life.

Regimens and drugs

Drugs for chemotherapy of lung cancer are prescribed taking into account the characteristics of the disease and the patient’s health condition.

The greatest effect was observed when using platinum derivatives:

  • (Carboplatin, Cisplatin),
  • taxanes (Docetaxel, Paclitaxel),
  • Etoposide,
  • Gemcitabine,
  • Irinotecana,
  • Pemetrexed,
  • Vinorelbina.

To increase the effectiveness of treatment and reduce the risk of persistent side effects, chemotherapy regimens usually include drugs from various groups.

Medicines can be prescribed orally (in tablets) or injected directly into the blood (intravenous or intra-arterial). At the same time, they spread throughout the body, that is, they act at the systemic level. On late stages For lung cancer, local chemotherapy is sometimes used - the injection of cytostatic solutions into the pleural cavity.

The duration and content of the course of therapy depends on the stage of the disease, tumor resistance to the action of cytostatics and other objective factors. Throughout the treatment, doctors monitor the patient’s condition, and if necessary, the regimen is adjusted.

In the world's leading specialized oncology centers, new protocols and chemotherapy regimens for patients with lung oncology are constantly being tested. Volunteer patients can take part in such trials if their diagnosis, age, characteristics of well-being and course of the disease meet the recruitment criteria. Such tests, among other things, are carried out in public and private oncology centers of the Russian Federation.

In 2019, as part of research programs In our country, in particular, the following studies were conducted:

  • assessment of the safety and effectiveness of nanodispersed camptothecin (CRLX101) - a 3rd line drug used to treat patients with advanced NSCLC - in the department of studying new antitumor drugs of the National Medical Research Center of Oncology named after. Blokhin;
  • analysis of the effect of Afatinib in patients with locally advanced or metastatic NSCLC with an EGFR (epidermal growth factor receptor) mutation - at the National Medical Research Center of Oncology named after. Blokhin;
  • A placebo-controlled phase III study examining the effect of ARQ 197 plus erlotinib in patients with locally advanced or metastatic non-squamous non-small cell lung cancer who had previously received standard chemotherapy with platinum drugs - in the Department of Tumor Biotherapy of the National Medical Research Center of Oncology. N.N. Blokhin;
  • evaluation of the efficacy and safety of seritinib at doses of 450 mg and 600 mg when taken with food containing a large number of fat, compared with taking the same drug on an empty stomach at a dose of 750 mg in patients with metastatic NSCLC with ALK-positive status - at the De Vita Center for Palliative Medicine in St. Petersburg

Possible consequences

The consequences of chemotherapy in the treatment of lung cancer are determined by the characteristics of the action of the prescribed drugs and other objective reasons.

Among the most common side effects are nausea, sometimes with vomiting, lack of appetite, fatigue, transient alopecia (baldness), decreased immunity.

Prevention of complications during treatment and recovery

To reduce the number and intensity of complications, it is necessary to follow the regimen recommended by the attending physician. First of all, this concerns good rest and diets.

Proper nutrition during chemotherapy and after treatment for lung cancer includes avoiding foods that can irritate the lining of the gastrointestinal tract. It is necessary to add jelly and mousses to the menu, as well as easily digestible foods rich in vitamins and proteins. Detailed recommendations regarding nutrition, work and rest schedule before discharge from the hospital can be obtained from the attending physician and nurse.

If you need a second opinion to clarify your diagnosis or treatment plan, send us an application and documents for consultation, or schedule an in-person consultation by phone.


For quotation: Gorbunova V.A. Chemotherapy of lung cancer // Breast cancer. 2001. No. 5. P. 186

Russian Oncology Research Center named after N.N. Blokhin RAMS

P The problem of chemotherapy for lung cancer is one of the most important in oncology. Lung cancer ranks first in incidence among all malignant tumors in men in all countries of the world and has a steady upward trend in incidence in women, accounting for 32% and 24% of cancer mortality, respectively. In the United States, 170,000 new cases are registered annually and 160,000 patients die from lung cancer.

It is fundamentally important to divide lung cancer according to morphological characteristics into 2 categories: not small cell cancer (NSCLC) And small cell carcinoma (SCLC). NSCLC, combining squamous cell, adenocarcinoma, large cell and some rare forms (bronchioloalveolar, etc.), accounts for approximately 75-80%. The share of MRL is 20-25%. At the time of diagnosis, most patients have a locally advanced (44%) or metastatic (32%) process.

Considering that most cases are diagnosed at an inoperable or conditionally operable stage tumor process, when there are metastases to the lymph nodes of the mediastinum, it becomes clear how important it is chemotherapy (CT) in the treatment of this category of patients. In patients with a disseminated process, the success of chemotherapy for 25 years until 1990 made it possible to extend the median survival by 0.8-3 months in SCLC and by 0.7-2.7 months. - with NSCLC. Analyzing numerous randomized trials on the treatment of 5746 patients with SCLC in 1972-1990. and 8436 patients with NSCLC in 1973-1994. B.E.Johnson (2000) comes to the conclusion that the median survival was extended to 2 months only in individual studies. However, it is associated with a 22% improvement; To statistically confirm this, large groups (about 840 patients) are needed, and therefore new methods for assessing the results of phase I and II clinical trials are proposed.

Small cell lung cancer

Small cell lung cancer (SCLC) is a tumor highly sensitive to chemotherapy. Treatment regimens have changed, and today several regimens have been identified as the main ones and the principles of combination treatment have been defined. At the same time, a large number of new drugs are emerging, which are gradually becoming of paramount importance in SCLC. SCLC tends to grow rapidly, progress, and metastasize. As a rule, the effectiveness of drug treatment is realized just as quickly. 2 courses of chemotherapy are sufficient to determine the sensitivity of the tumor in a particular patient. Maximum effect usually achieved after 4 courses. Total at effective treatment conduct 6 courses.

Numerous literature data on the timing and location of radiotherapy (RT) are contradictory. Most authors believe that radiation therapy should be as close as possible to chemotherapy and can be carried out either in combination simultaneously or after 2-3 courses of chemotherapy.

According to a meta-analysis, survival of patients with localized SCLC (LSCL) increases with the addition of radiation therapy to chemotherapy. But this improvement is significant if radiation therapy begins simultaneously with the 1st cycle of chemotherapy. In this case, 2-year survival increased by 20% (from 35% to 55%, p = 0.057), in contrast to when RT was administered sequentially after the 4th cycle of chemotherapy. Much attention is paid to the irradiation technique: hyperfractionation using 1.5 Gy twice a day in 30 fractions (up to 45 Gy in 3 weeks) simultaneously with the 1st cycle of the EP combination (etoposide, cisplatin) allowed to achieve 47% 2-year survival rate and 26% 5-year survival rate.

Patients with prospects for prolonged survival, i.e. those with PR require prophylactic irradiation of the brain in order to reduce the likelihood of metastasis to the brain and improve survival.

There has been a renewed increase in the involvement of surgeons in the treatment of SCLC. Early stages of the disease are treated with surgery followed by adjuvant chemotherapy. The 5-year survival rate reaches 69% for stage I, 38% for stage II and 40% for stage IIIA disease (etoposide + cisplatin was used adjuvantly).

1) etoposide + cisplatin (or carboplatin); or

2) etoposide + cisplatin + taxol,

and in the 2nd line of treatment, i.e. after resistance to first-line drugs occurs, combinations including doxorubicin can be used.

In the treatment of advanced SCLC in studies conducted in Russia, it was shown that the combination of a new nitrosourea derivative drug Nidran (ACNU) (3 mg/kg on the 1st day for the 1st course of treatment and 2 mg/kg for subsequent cases) hematological toxicity), etoposide (100 mg/m2 on days 4, 5, 6) and cisplatin (40 mg/m2 on days 2 and 8) with repeated courses every 6 weeks is highly effective against the metastatic process. The following sensitivity was noted: liver metastases - 72% (in 8 out of 11 patients, complete effect (PR) - in 3 out of 11); in the brain - 73% (11/15 patients, PR - 8/15); adrenal glands - 50% (5/10 patients, PR - 1/10); bones - 50% (4/8 patients, CR - 1/8). The overall objective effect was 60% (PR - 5%). This combination is superior in effectiveness to others and in long-term results: the median survival (MS) was 12.7 months compared to 8.8 months when using combinations with doxorubicin. In the chemotherapy department of the Russian Cancer Research Center, this combination is used as the 1st line of chemotherapy in advanced cases as the most effective.

Murray N. (1997) suggests a combination of SODE (cisplatin + vincristine + doxorubicin + etoposide) for a common process using a once-weekly dosing regimen, which caused long-term remissions with a CF of 61 weeks and a 2-year survival rate of 30%.

In patients with LSCLC, the chemotherapy department of the Russian Cancer Research Center in the past used a combination of CAM: cyclophosphamide 1.5 g/m2, doxorubicin 60 mg/m2 and methotrexate 30 mg/m2 intravenously on the 1st day with an interval of 3 weeks between courses. Its effectiveness in combination with subsequent radiation therapy was 84% ​​with CR in 44% of patients; CF 16.2 months and 2.5-year survival rate 12%.

IN last years New drugs are being intensively studied: Taxol, Taxotere, Gemzar, Campto, Topotecan, Navelbine and others. Taxol in doses of 175-250 mg/m2 it was effective in 53-58% of patients, as a 2nd line - in 35% of patients. Particularly impressive results were achieved when using a combination of taxol with carboplatin - 67-82%, PR - 10-18% and with etoposide and cis- or carboplatin: effectiveness 68-100%, PR up to 56%.

For SCLC in monotherapy, effectiveness Taxotere was 26%, in combination with cisplatin - 55%.

Since 1999, the Chemotherapy Department of the Russian Cancer Research Center has been studying combination chemotherapy with Taxotere 75 mg/m2 and cisplatin 75 mg/m2 in 16 patients with SCLC (common process). The effectiveness of the combination was 50% with CR in 2 patients; the median duration of effect was 14 weeks; The median life expectancy is 10 months in patients with effect, 6 months in patients without effect. It is important to note that CR was achieved for metastases in the liver (33%), adrenal glands in 1 out of 4 patients, retroperitoneal lymph nodes in 2 out of 5 patients, and with pleural lesions in 2 out of 3 patients.

Efficiency Navelbine reaches 27%. The drug is quite promising for use in various drug combinations. Topoisomerase I inhibitor - campto ( irinotecan ) was studied in the USA in phase II. Its effectiveness was 35.3% in patients with chemotherapy-sensitive tumors and 3.7% in patients with refractory ones. Combinations with campto are effective in 49-77% of patients. Efficiency topotecan for SCLC it is 38%.

On average, the effectiveness of new drugs as 1st line of treatment is 30-50% (Table 1) and they continue to be intensively studied in combination regimens, so the possibility of changing approaches to the choice of 1st line chemotherapy cannot be ruled out in the near future.

Non-small cell lung cancer

In contrast to SCLC, non-small cell lung cancer until recently belonged to the category of tumors that were not very sensitive to chemotherapy. However, chemotherapy has been firmly introduced into the methods of treating this disease literally in the last 10 years. This was due to published studies showing a survival advantage in patients who received chemotherapy compared with patients who received the best treatment. symptomatic treatment(advantage in CF - 1.7 months, in 1-year survival - 10%), and due to the emergence of 6 new effective antitumor drugs at the same time.

Along with the improvement in treatment results, the quality of life of patients receiving chemotherapy has also improved with the introduction of platinum-containing regimens.

The multicenter randomized ECOG trial in stages IIIB and IV also demonstrated improved survival (MV - 6.8 months and 4.8 months) and quality of life in 79 patients in the taxol + best symptomatic therapy group compared with 78 patients who received only symptomatic treatment .

The standard regimen in the treatment of patients with NSCLC is replacing the EP regimen (etoposide + cisplatin). combinations of Taxol with cis- or carboplatin and Navelbine with cisplatin.

The effectiveness of new anticancer drugs varies from 11 to 36% when used as the 1st line of treatment and from 6 to 17% when used as the 2nd line (Table 2).

The main focus is currently on studying combination chemotherapy regimens with new drugs. Randomized trials comparing a new agent (navelbine, paclitaxel, or gemcitabine) in combination with cisplatin versus cisplatin alone showed a survival benefit for the combinations. Randomized trials of the new combination versus the standard (ER) demonstrated an improvement in survival for the paclitaxel and cisplatin group in one of them and a quality of life benefit in patients treated with taxol.

Thus, combinations of a new drug with cisplatin or carboplatin are promising for the treatment of advanced stages of NSCLC. Comparison of navelbine with cisplatin and paclitaxel with carboplatin showed similar results (efficacy 28% and 25%; MFS 8 months in both groups; 1-year survival 36% and 38%, respectively).

Much attention is paid to studying 3-component modes, including navelbine, taxol, gemzar with platinum derivatives in various combinations. The effectiveness of these combinations ranges from 21 to 68%, median survival is from 7.5 to 14 months, 1-year survival is 32-55%. The best results were obtained from the combination of navelbine 20-25 mg/m2, gemzar 800-1000 mg/m2 on days 1 and 8 and cisplatin 100 mg/m2 on day 1. With this regimen, the limiting toxicity was neutropenia (grade III - 35-50%).

Non-platinum combinations were also quite effective - up to 88% with docetaxel and navelbine. 6 studies of this combination show differences in dose regimens (docetaxel 60-100 mg/m2 and navelbine 15-45 mg/m2) and effectiveness - 20-88%. In 4 of them, hematopoietic growth factors were used prophylactically. CF according to the results of 2 studies was 5 and 9 months, 1-year survival rate was 24% and 35%. Summary results of combinations of new drugs without platinum derivatives were analyzed by K. Kelly (2000) (Table 2).

Newly studied agents in NSCLC include tirapazamine - a unique compound that damages cells in a state of hypoxia, the fraction of which in tumors is 12-35%, and which are difficult to treat with traditional cytostatics. A study of tirapazamine 390 mg/m2 and cisplatin 75 mg/m2 every 3 weeks in 132 patients showed good tolerability, 25% efficacy and 1-year survival of 38%. Study started oxaliplatin single and in combination regimens, as well as the drug UFT (tegafur + uracil) and multidamaging antifolate (MTA).

The importance of chemotherapy and at operable stages NSCLC. For operable stages, and especially for stages IIIA-IIIB of the disease, neoadjuvant and adjuvant chemotherapy regimens are being studied. Despite a recent meta-analysis of all randomized trials from 1965-1991, which showed a reduction in the absolute risk of death by 3% by 2 years of follow-up and by 5% by 5 years for patients receiving postoperative cisplatin-containing courses of chemotherapy, compared with only surgery, these data did not serve as a basis to consider this method standard.

Meta-analysis of meaning postoperative radiotherapy There was no survival benefit compared with surgery alone. However, there is a tendency to analyze different groups of patients separately. At stage IIIB the combination of cisplatin-containing regimens and RT has advantages over RT alone. The simultaneous combination of these types of treatment is better than sequential ones. Considering the radiosensitizing properties of new antitumor agents, the prerequisites are created for safe, effective combination therapy. The active regimen is taxol with carboplatin. Its effectiveness was 69% in stage IIIA. The use of a weekly regimen is promising: taxol 45-50 mg/m2 and carboplatin 100 mg/m2 or AUC-2 in combination with radiation therapy. New radiotherapy techniques are being developed: hyperfractionation or continued acceleration and hyperfractionation. To reduce toxicity (particularly esophagitis), new liposomal protective factors are being studied.

More careful attention is paid to the selection of patients for each type and stage of treatment. Thus, it was shown that only patients with N2 (the presence of morphologically confirmed metastases in the mediastinal lymph nodes) had improved results from postoperative RT, and for patients with N0-1 this was not confirmed.

Neoadjuvant chemotherapy with taxol (225 mg/m2) and carboplatin - AUC-6 on days 1 and 22 followed by surgery in patients with IB-II and T3N1 NSCLC caused an objective effect in 59% with a 1-year survival rate of 85%.

Various durations of postoperative regimens are being studied. Neoadjuvant chemotherapy with cisplatin 50 mg/m2 + ifosfamide 3 g/m2 + mitomycin 6 mg/m2 every 3 weeks - 3 cycles compared with surgery in 60 patients with stage IIIA, 44 of whom had involvement of the mediastinal lymph nodes, showed a significant survival advantage in group of patients with chemotherapy (CF - 26 months and 8 months, respectively). Both groups also received postoperative radiation therapy.

The combination of cyclophosphamide 500 mg/m2 on day 1 with etoposide 100 mg/m2 on days 1, 2, 3 and cisplatin 100 mg/m2 on day 1 every 4 weeks - 3 cycles before surgery was better than surgery alone ( CF 64 months and 11 months, respectively). Patients with effect received 3 additional courses after surgery.

In parallel and independently, molecular mechanisms of resistance, tubulin and gene mutations are studied depending on sensitivity to chemotherapy, relapse and survival.

Advances in biotechnology have led to the creation of agents that act at the level of specific cellular changes and control cell growth and proliferation. Currently under investigation: ZD 1839, which blocks signal transduction through epidermal growth factor receptors; monoclonal antibodies - trastuzumab (Herceptin), which inhibits tumor growth by acting on the HER 2/neu gene product, overexpression of which is present in 20-25% of lung cancer patients, blockers of epidermoid growth factors and tyrosine kinase activity, etc. . All this gives hope for an imminent future breakthrough in the treatment of lung cancer.

The list of references can be found on the website http://www.site

Literature:

1. Orel N.F. Opportunities for improving conservative treatment small cell cancer lung Abstract of doctoral dissertation. Moscow. 1997.

2. Belani C., Natale R., Lee J., et al. Randomized phase III trial comparing cisplatin / etoposide versus carboplatin / paclitaxel in advance and metastatic non-small cell lung cancer (NSCLC). Proc. ASCO, 1998, 455a (abstr.1751).

3. Belani Ch.P. Integration of Taxol with Radiotherapy in the management of locally advanced NSCLC. 4th Pan-European Cancer-Symposium - A New Era in the Management of Lung Cancer.. Cannes. France. 2000. Abstract book. 21-22.

4. Bonner J.A., Sloan J.A., Shanahan T.G., et al. Phase III comparison of twice-daily split-course irradiation versus once-daily irradiation for patients with limited stage small-cell lung carcinoma. J. Clin. Oncol., 1999, 17: 2681-2691.

5. Bonomi P., Kim K., Chang A., et al. Phase III trial comparing etoposide, cisplatin versus taxol with cisplatin - G-CSF versus taxol - cisplatin in advanced non-small cell lung cancer: An Eastern Cooperative Oncology Group (ECOG) trial. Proc. ASCO, 1996, 15:382 (abstr.1145).

6. Cullen M.H., Billingham L.J., Woodroffe C.M., et al. Mitomycin, ifosfamide and cisplatin in unresectable non-small-cell lung cancer: Effects on survival and quality of life. J. Clin. Oncol., 1999, 17:3188-3194.

7. Giaccone G. Neoadjuvant Chemotherapy in locally advanced NSCLC. 4th Pan-European Cancer-Symposium - A New Era in the Management of Lung Cancer. Cannes. France. 2000. Abstract book. 19-20.

8. Giaccone G., Postmus P., Debruyne C., et al. Final results of an EORTC phase III study of paclitaxel vs teniposide, in combination with cisplatin in advanced NSCLC. Proc. ASCO, 1997, 16;460a (abstr.1653).

9. Goto K., Nishiwaski Y., Takada M., et al. Final results of a phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited small cell lung cancer. The Japan Clinical Oncology Group Study. Proc. ASCO, 1999, 18:468a (abstr.1805).

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11. Kelly K. Future Directions for new cytotoxic agents in the treatment of advanced stage non-small-cell lung cancer. ASCO 2000. Educational Book. 357-367.

12. Kris M.G., Laurie S.A., Miller V.A. Integrating New Agents and Approaches into Chemotherapy Regimens for Non-Small-cell Lung Cancer. ASCO 2000. Educational Book, 368-374.

13. Landis S.H., Murray T., Bolden S., et al. Cancer statistics, 1998, Cancer J. Clin. 1998, 48:6-29.

14. Le Chevalier Th. Induction Treatment in Operable NSCLC. 4th Pan-European Cancer-Symposium - A New Era in the Management of Lung Cancer. Cannes. France. 2000. Abstract book. 15-16.

15. Murray N. Treatment of SCLC: the study of the art. Lung cancer, 1997, 17, 75-89.

16. Pignon J.P., Arrigada R., Ihde D.C., et al. A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N.Engl. J Med 1992, 327: 1618-1624.

17. Sandler A., ​​Nemunaitis J., Deham C., et al. Phase III study of cisplatin with or without gemcitabine in patients with advanced non-small cell lung cancer (NSCLC). Proc. ASCO, 1998, 14:454a (abstr.1747).

18. Suzuki R., Tsuchiya Y., Ichinose Y., et al. Phase II trial of postoperative adjuvant cisplatin/etoposide (PE) in patients with completely resected stage I-IIIA small cell lung cancer (SCLC): the Japan Clinical Oncology Lung cancer Study Group Trial (JCOG9101). Proc. ASCO, 2000, vol.19, 492a (abstr1925).

19. Thatcher N., Ranson M., Burt P., et al. Phase III Trial of Taxol plus best supportive care versus best supportive care alone in inoperable NSCLC. 4th Pan-European Cancer-Symposium - A New Era in the Management of Lung Cancer. Cannes. France. 2000. Abstract book. 9-10.

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On this moment Chemotherapy for lung cancer is the treatment method that brings the greatest results. It involves the use of cytotoxic (anti-cancer) drugs to destroy and disrupt the growth of diseased cancer cells.

Chemotherapy is prescribed by an oncologist and is carried out in cycles of usually three to four weeks.

When and how chemotherapy treatment is prescribed

Chemotherapy for lung cancer is prescribed taking into account the stage and extent of the disease, as self-treatment, as well as in combination with radiotherapy (radiation therapy).

“Chemotherapy” is the main remedy for getting rid of small cell lung cancer, since it responds very well to chemotherapy. Also, a feature of small cell cancer is that it often spreads beyond the diseased lung. And the drugs used in chemotherapy circulate in the blood throughout the body. And so they can treat cells that have broken off from the lung tumor and spread to other organs.

In the case of small cell lung cancer, chemotherapy is used alone or in combination with radiotherapy. When the cancer is operable, the procedure may be done before surgery to reduce the size malignant formation. After surgery (sometimes along with x-ray therapy), the doctor will prescribe chemotherapy to try to kill any diseased cells that may remain in the body.

Chemotherapy is also used to treat non-small cell cancer lungs. It may be prescribed before or after surgery. It will help shrink the cancer and make the tumor easier to remove.

In the early stages of non-small cell cancer, chemotherapy will help reduce the risk of recurrence after surgery. For this type of disease, “chemistry” can be used in combination with radiotherapy. Especially when surgery is not recommended for the patient for a number of reasons.

For advanced cancer, chemotherapy is more supportive. It can help a patient live longer if the disease can no longer be cured.

Chemotherapy is often prohibited for patients in poor health. But receiving “chemistry” is not prohibited for older people.

Chemotherapy drugs and procedure

The following drugs are most commonly used for chemotherapy:

  • "Cisplatin";
  • "Taxol" (Paclitaxel);
  • "Docetaxel";
  • "Navelbine" (Vinorelbine);
  • "Gemzar" (Gemcitabine);
  • "Kamptosar";
  • Pemetrexed.

Often a combination of 2 drugs is used for treatment. Experience shows that adding a third chemotherapy drug does not provide significant benefit and often causes many side effects. Single-drug chemotherapy is sometimes used for people who cannot tolerate combination chemotherapy due to poor condition general health or older age.

For reference: doctors usually carry out chemotherapy for 1-3 days. This is followed by a short rest to give the body time to recover. Chemo cycles typically last 3 to 4 weeks.

For advanced disease, chemotherapy is often given over four to six cycles. The findings suggest that such long-term treatment, called maintenance therapy, curbs cancer progression and can help people live longer.

Possible side effects and negative effects

Chemotherapy drugs affect cells that multiply quickly. In this regard, they are used against cancer cells. But other (healthy) cells in the body, such as cells in the spinal cord, intestinal and oral mucosa, and hair follicles, also have the ability to rapidly divide. Unfortunately, drugs can also penetrate into these cells, which leads to certain undesirable consequences.

The negative effects of chemotherapy depend on the dose and type of medications, as well as the length of time they are taken.

The main side effects are:

  • the appearance of ulcers in the mouth and tongue;
  • significant hair loss and baldness;
  • lack of appetite;
  • vomiting and nausea;
  • gastrointestinal disorders – diarrhea, constipation;
  • increased likelihood of infections (due to the decrease in the number of leukocytes in the blood);
  • bleeding (due to a decrease in the number of red blood cells);
  • general fatigue and tiredness.

These side effects almost always stop upon completion of treatment. And modern medicine has many ways to reduce negative effect from chemotherapy. For example, there are drugs that help prevent vomiting and nausea and reduce hair loss.

The use of certain drugs, such as Cisplatin, Docetaxel, Paclitaxel, can cause peripheral neuropathy– nerve damage. Sometimes this can lead to symptoms (mainly in the extremities) such as burning, pain, tingling, sensitivity to heat or cold, and weakness. For most people, these symptoms go away once treatment is stopped.

Patients should always inform their doctor about any side effects they notice. In some cases, the dose of chemotherapy drugs may be reduced. And sometimes it is necessary to stop treatment for a while.

Nutrition during chemotherapy

People undergoing chemotherapy must eat well and properly. This will help them feel better and stay strong, prevent loss bone tissue And muscle mass. Good food helps fight infections and is of great importance in treating cancer and improving quality of life. Food should be enriched with vitamins and beneficial microelements.

Since the body is under stress during chemotherapy, it is necessary to consume plenty of protein to promote healing and get the immune system working again. Red meat, chicken, and fish are excellent sources of protein and iron. There is a lot of protein in foods such as cheese, beans, nuts, eggs, milk, cottage cheese, yogurt.

Because of mouth ulcers that appear during chemotherapy, it may be difficult for a patient to drink citrus juices or eat citrus fruits, which are among the most common sources of vitamin C. They can be replaced with alternative ways to obtain this vitamin - peaches, pears, apples, as well as juices and nectars from these fruits.

Important! All fruits and vegetables need to be washed very well because the immune system becomes more susceptible to contaminants in food.

Chemotherapy and radiation can also lead to dehydration. And some medications can cause kidney failure if they are not eliminated from the body. Therefore, it is essential to stay hydrated during cancer treatment.

Chemotherapy currently shows good results in the treatment of lung cancer. However, many chemotherapy drugs cause side effects. Therefore, it is necessary to constantly keep in touch with your doctor, who will help you choose the right care to improve the patient’s quality of life.

Cytostatic chemotherapy for lung cancer is the main method of treatment along with surgical intervention And radiation exposure. The use of these drugs has Negative influence on pathological cells, reducing their ability to divide and develop, which leads to a decrease in tumor size and prevents cancer progression.

Indications

Treatment of lung cancer with chemotherapy is used for the following purposes:

  • reducing tumor size before surgery;
  • therapy in the postoperative period;
  • monotherapy for early stages development of a neoplasm or in inoperable cases;
  • ineffectiveness of other methods;
  • palliative treatment for stage 4 tumors with metastases.

What drugs are used?


When affected by a malignant lung tumor, cytostatics are used, including Doxorubicin.

Therapy with cytostatics for malignant neoplasms the respiratory system does not have specific medicines. Combinations of the following medications are used:

  • "Vincristine";
  • "Cyclophosphamide";
  • "Doxorubicin";
  • "Vinblastine";
  • "Mitomycin";
  • "Docetaxel";
  • "Paclitaxel";
  • "Etoposide";
  • "Carboplatin";
  • "Cisplatin";
  • "Navelbine."

Medication regimens

Chemotherapy drugs for lung cancer are selected separately for each patient. The choice of drugs depends on the degree of development of the tumor, the type of atypical cells, and sensitivity to different pharmacological groups. In the clinic, treatment regimens are designated by abbreviations:

  • CAV - Cyclophosphamide, Doxorubicin, Vincristine. This combination is most often prescribed for stages 1-3 of squamous cell lung cancer.
  • ACE - the same scheme as the previous one, with a change last drug to "Etoposide".
  • VMP - includes Vinblastine, Cisplatin and Mitomycin C. It is most effective as chemotherapy for lung metastases.

Preparation and execution


Before prescribing treatment, a biopsy of the tumor is performed, based on the results of which suitable medications are selected.

Before prescribing a chemotherapy regimen, the patient undergoes many studies to determine the specific genotype of cancer, the degree of malignancy of the cells and sensitivity to cytostatic agents. A tumor biopsy and specific immunohistochemical study are performed. This is necessary to select the ideal combination of drugs in each individual case.

Chemotherapy is administered in courses of 14, 21 or 28 days with breaks of 3 weeks. Their number depends on the effectiveness of treatment and the reactivity of pathological tissues to cytostatics. At stages 1-2, treatment helps after the first course of drug administration; at stages 3-4, medications are used 5-8 times. The intervals between courses are necessary to allow the immune system and red bone marrow to recover to further fight cancer. Medicines are administered intravenously.

Chemotherapy drugs also come in tablets, but not all drugs come in this form.

Restrictions

For cancer of the respiratory system, chemistry is prohibited in the following cases:


The use of chemotherapy has a number of contraindications, including acute renal failure.
  • acute infection;
  • fever;
  • severe liver pathologies;
  • diseases of the cardiovascular system;
  • diabetes mellitus at the stage of decompensation;
  • profound anemia;
  • low levels of white blood cells and platelets;
  • period of pregnancy and lactation;
  • acute renal failure.

Negative consequences

Chemotherapy helps fight malignant cells, but at the same time affects healthy tissue, which results in many side effects. General reactions include general weakness, malaise, decreased muscle strength, impaired memory and mental activity, changes in normal sleep and wakefulness, and baldness.

The most dangerous complications arise from the immune system. Chemotherapy leads to depletion of red bone marrow, decreased shaped elements blood. This is manifested by a decrease in immune resistance to infectious agents, negative factors internal and external environment. As a result, a secondary infection occurs with the development of protracted inflammatory processes that are difficult to treat.


The consequences of the procedure are intestinal disorders, accompanied by nausea and loss of appetite.

Other effects of chemotherapy for lung cancer include:

  • Gastrointestinal tract dysfunctions:
    • nausea;
    • vomit;
    • heartburn;
    • abdominal discomfort;
    • aversion to meat food;
    • lack of appetite;
    • change in stool.
  • Depression.
  • Apathy.
  • A sharp decrease in body weight.
  • Impaired kidney function.
  • Hypovitaminosis.
  • Headache.
  • Muscle weakness.

In world statistics, among all malignant tumors, lung cancer ranks first in terms of mortality. The five-year survival rate for patients is 20%, meaning four out of five patients die within a few years of diagnosis.

The difficulty is that initial stages bronchogenic cancer is difficult to diagnose (it cannot always be seen on conventional fluorography), the tumor quickly forms metastases, as a result of which it becomes unresectable. About 75% of newly diagnosed cases are cancer with metastatic foci (local or distant).

Treatment of lung cancer is a pressing problem throughout the world. It is the dissatisfaction of specialists with the results of treatment that motivates them to search for new methods of influence.

Main directions

The choice of tactics directly depends on histological structure tumors. Basically, there are 2 main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), which includes adenocarcinoma, squamous cell and large cell cancer. The first form is the most aggressive and forms metastatic foci early. Therefore, in 80% of cases, drug treatment is used. With the second histological option, the main method is surgical.

Operation. Currently, it is the only radical option for influence.

Chemotherapy.

Targeted and immunotherapy. Relatively new treatment methods. Based on targeted, precise influence on tumor cells. Not all lung cancers are suitable for this treatment, only certain types of NSCLC with certain genetic mutations are.

Radiation therapy. It is prescribed to patients for whom surgery is not indicated, as well as as part of a combined method (preoperative, postoperative irradiation, chemoradiotherapy).

Symptomatic treatment is aimed at alleviating the manifestations of the disease - cough, shortness of breath, pain and others. It is used at any stage, it is the main one in the terminal stage.

Surgical intervention

Surgical treatment is indicated for all patients with non-small cell lung cancer from stages 1 to 3. With SCLC from 1st to 2nd stage. But, given the fact that the detection rate of neoplasms at an early stage of development is extremely low, surgical intervention is performed in no more than 20% of cases.

Main types of operations for lung cancer:

  • Pulmonectomy – removal of the entire organ. The most common surgical treatment option, performed when the tumor is centrally located (with damage to the main bronchi).
  • Lobectomy – removal of a lobe, the indication is the presence of a peripheral formation emanating from small airways.
  • Wedge resection – removal of one or more segments. It is performed rarely, more often in weakened patients and in cases of benign neoplasms.

Contraindications for surgery:

  • Presence of distant metastases.
  • Heavy general state, decompensated concomitant diseases.
  • Chronic lung pathologies with existing respiratory failure.
  • The tumor is located close to the mediastinal organs (heart, aorta, esophagus, trachea).
  • Age over 75 years.

Before the operation, the patient is prepared: anti-inflammatory, restorative treatment, correction of violations of the basic functions of the body.

The operation is often performed using the open method (thoracotomy), but it is possible to remove a lobe of the organ through thoracoscopic access, which is less traumatic. Together with lung tissue Regional lymph nodes are also removed.

Adjuvant chemotherapy is usually given after surgery. It is also possible to perform surgical treatment after preoperative (neoadjuvant) chemoradiotherapy.

Chemotherapy

According to WHO, chemotherapy for lung cancer is indicated for 80% of patients. Chemotherapy drugs are drugs that either block the metabolism of tumor cells (cytostatics) or directly poison the tumor (cytotoxic effects), as a result of which their division is disrupted, the carcinoma slows down its growth and regresses.

For the treatment of malignant lung tumors, platinum drugs (cisplatin, carboplatin), taxanes (paclitaxel, docetaxel), gemcitabine, etoposide, irinotecan, cyclophosphamide and others are used as the first line.

For the second line - pemetrexed (Alimta), docetaxel (Taxotere).

Combinations of two drugs are usually used. Courses are conducted at intervals of 3 weeks, the number is from 4 to 6. If 4 courses of first-line treatment are ineffective, second-line regimens are used.

Treatment with chemotherapy for more than 6 cycles is not advisable, since their side effects will prevail over the benefits.

Goals of chemotherapy for lung cancer:

  • Treatment of patients with an advanced process (stages 3-4).
  • Neoadjuvant preoperative therapy to reduce the size of the primary lesion and influence regional metastases.
  • Adjuvant postoperative therapy to prevent relapse and progression.
  • As part of chemoradiation treatment for inoperable tumors.

Different histological types of tumors have different responses to drug exposure. For NSCLC, the effectiveness of chemotherapy ranges from 30 to 60%. In SCLC, its effectiveness reaches 60-78%, with 10-20% of patients achieving complete regression of the tumor.

Chemotherapy drugs act not only on tumor cells, but also on healthy ones. Side effects from such treatment are usually unavoidable. These are hair loss, nausea, vomiting, diarrhea, inhibition of hematopoiesis, toxic inflammation of the liver and kidneys.

This treatment is not prescribed for acute infectious diseases, decompensated diseases of the heart, liver, kidneys, blood diseases.

Targeted therapy

This is a relatively new and promising method for treating tumors with metastases. While standard chemotherapy kills all rapidly dividing cells, targeted drugs selectively act on specific target molecules that promote the proliferation of cancer cells. Accordingly, they are deprived of those side effects, which we observe in the case of conventional circuits.

However, targeted therapy is not suitable for everyone, but only for patients with NSCLC in the presence of certain genetic mutations in the tumor (no more than 15% of the total number of patients).

This treatment is used in patients with stages 3-4 cancer more often in combination with chemotherapy, but it can also act as independent method in cases where chemotherapy drugs are contraindicated.

The EGFR tyrosine kinase inhibitors gefinitib (Iressa), erlotinib (Tarceva), afatinib, and cetuximab are currently widely used. The second class of such drugs are inhibitors of angiogenesis in tumor tissue (Avastin).

Immunotherapy

This is the most promising method in oncology. Its main task is to strengthen the body’s immune response and force it to fight the tumor. The fact is that cancer cells are susceptible to various mutations. They form protective receptors on their surface that prevent them from being recognized by immune cells.

Scientists have developed and continue to develop drugs that block these receptors. These are monoclonal antibodies that help the immune system defeat foreign tumor cells.

Radiation therapy

Treatment ionizing radiation is aimed at damaging the DNA of cancer cells, as a result of which they stop dividing. For such treatment, modern linear accelerators are used. For lung cancer, external beam radiation therapy is mainly performed, when the radiation source does not come into contact with the body.

Radiation treatment used in patients with both localized and advanced lung cancer. At stages 1-2, it is performed in patients with contraindications to surgery, as well as in inoperable patients. More often it is carried out in combination with chemotherapy (simultaneously or sequentially). Chemoradiation is the main method in the treatment of localized small cell lung cancer.

For brain metastases of SCLC, radiation therapy is also the main treatment method. Irradiation is also used as a way to relieve symptoms of compression of the mediastinal organs (palliative irradiation).

The tumor is first visualized using CT, PET-CT, and marks are applied to the patient’s skin to direct the rays.

To a special computer program Tumor images are loaded and impact criteria are formed. During the procedure, it is important not to move and hold your breath at the doctor’s command. Sessions are held daily. There is a hyperfractional intensive technique, when sessions are carried out every 6 hours.

The main negative consequences of radiation therapy: the development of esophagitis, pleurisy, cough, weakness, difficulty breathing, and rarely, skin damage.

The cyber knife system is the most modern technique radiation treatment of tumors. It can act as an alternative to surgery. The essence of the method is a combination of precise control over the location of the tumor in real time and the most accurate irradiation of it with a robot-controlled linear accelerator.

The impact occurs from several positions, the radiation flows converge in the tumor tissue with millimeter precision, without affecting healthy structures. The effectiveness of the method for some tumors reaches 100%.

The main indications for the CyberKnife system are stage 1-2 NSCLC with clear boundaries up to 5 cm in size, as well as single metastases. You can get rid of such tumors in one or several sessions. The procedure is painless, bloodless, and is performed on an outpatient basis without anesthesia. This does not require strict fixation and breath holding, as with other irradiation methods.

Principles of treatment of non-small cell lung cancer

Stage 0 (intraepithelial carcinoma) – endobronchial excision or open wedge resection.

  • I Art. - surgical treatment or radiation therapy. Segmental resection or lobectomy with excision of mediastinal lymph nodes is used. Radiation treatment is carried out for patients with contraindications to surgery or who refuse it. Stereotactic radiotherapy provides the best results.
  • II Art. NSCLC – surgical treatment (lobectomy, pneumonectomy with lymphadenectomy), neoadjuvant and adjuvant chemotherapy, radiation therapy (if the tumor is inoperable).
  • III Art. – surgical removal of resectable tumors, radical and palliative chemoradiotherapy, targeted therapy.
  • IV Art. – combination chemotherapy, targeted, immunotherapy, symptomatic radiation.

Principles of treatment of small cell lung cancer by stage

To better define treatment approaches, oncologists divide SCLC into localized stage (within one half of chest) and an extensive stage (spreading beyond the localized form).

For a localized stage the following is used:

  • Complex chemoradiotherapy followed by prophylactic irradiation of the brain.
    Platinum drugs are most often used for chemotherapy in combination with etoposide (EP regimen). 4-6 courses are carried out with an interval of 3 weeks.
  • Radiation treatment given simultaneously with chemotherapy is considered preferable to their sequential use. It is prescribed with the first or second course of chemotherapy.
  • The standard irradiation regimen is daily, 5 days a week, 2 Gy per session for 30-40 days. The tumor itself, the affected lymph nodes, and the entire volume of the mediastinum are irradiated.
  • The hyperfractionated regime is two or more irradiation sessions per day for 2-3 weeks.
  • Surgical resection with adjuvant chemotherapy for stage 1 patients.
    With the right and complete treatment localized forms of SCLC achieve stable remission in 50% of cases.

For advanced stage SCLC, the main method is combination chemotherapy. Most efficient scheme– this is EP (etoposide and platinum drugs), other combinations can be used.

  • Radiation is used for metastases in the brain, bones, adrenal glands, and also as a method of palliative treatment for compression of the trachea and superior vena cava.
  • If chemotherapy has a positive effect, prophylactic cranial irradiation is performed; it reduces the incidence of brain metastases by 70%. Total dose – 25 Gy (10 sessions of 2.5 Gy).
  • If after one or two courses of chemotherapy the tumor continues to progress, it is not advisable to continue it, the patient is recommended only symptomatic treatment.

Antibiotics for lung cancer

In patients with lung cancer, there is a decrease in local and general immunity, as a result of which bacterial inflammation, pneumonia, which complicates the course of the disease, can quite easily occur in the altered lung tissue. At the stage of treatment with cytostatics and radiation, activation of any infection is also possible, even opportunistic flora can cause a serious complication.

Therefore, antibiotics for lung cancer are used quite widely. It is advisable to assign them taking into account bacteriological research microflora.

Symptomatic treatment

Symptomatic treatment is used at any stage of lung cancer, but at the terminal stage it becomes the main treatment and is called palliative. This treatment is aimed at alleviating the symptoms of the disease and improving the patient’s quality of life.

  • Cough relief. A cough with lung cancer can be dry, hacking (it is caused by irritation of the bronchi by a growing tumor) and wet (with concomitant inflammation of the bronchi or lung tissue). For a dry cough, antitussives (codeine) are used, and for a wet cough, expectorants are used. Warm drinks and inhalations also relieve coughs. mineral water and bronchodilators via nebulizer.
  • Reduced shortness of breath. For this purpose, aminophylline preparations, inhaled bronchodilators (salbutamol, berodual), corticosteroid hormones (beclomethasone, dexamethasone, prednisolone and others) are used.
  • Oxygen therapy (inhalation of a breathing mixture enriched with oxygen). Reduces shortness of breath and symptoms of hypoxia (weakness, dizziness, drowsiness). With the help of oxygen concentrators, oxygen therapy can be performed at home.
  • Effective pain relief. The patient should not experience pain. Analgesics are prescribed according to the scheme of strengthening the drug and increasing the dose, depending on their effect. They start with non-steroidal anti-inflammatory drugs and non-narcotic analgesics, then it is possible to use weak opiates (tramadol), and gradually move on to narcotic drugs (promedol, omnopon, morphine). The analgesic groups of morphine also have an antitussive effect.
  • Removing fluid from the pleural cavity. Lung cancer is often accompanied by effusion pleurisy. This aggravates the patient’s condition and worsens shortness of breath. The fluid is removed by thoracentesis - a puncture of the chest wall. To reduce the rate of fluid reaccumulation, diuretics are used.
  • Detoxification therapy. To reduce the severity of intoxication (nausea, weakness, fever), infusion support is provided saline solutions, glucose, metabolic and vascular drugs.
    Hemostatic agents for bleeding and hemoptysis.
  • Antiemetic drugs.
  • Tranquilizers and neuroleptics. They enhance the effect of analgesics, reduce the subjective feeling of shortness of breath, relieve anxiety, and improve sleep.

Conclusion

Lung cancer is a disease in most cases with a poor prognosis. However, it can be treated at any stage. The goal can be either complete recovery or slowing down the progression of the process, relieving symptoms and improving quality of life, as with any chronic disease.

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