Dorset Cancer Network Last updated Nov 2012 Standard Regimens for Lung Cancer Chemotherapy Regimen Gem/Carbo Gemcitabine 1200mg/m² Inf D1 & 8 Carboplatin AUC 6*(Calc CrCl) Inf D1 Cycle Length 3/52 Cycle Setting Non Small Cell Lung First line option for advanced stage. Status NICE endorsed Pemetrexed/Cisplatin (NSCLC) Pemetrexed 500mg/m2 IV D1 Cisplatin 75mg/m2 Inf D1 3/52 Non Small Cell Lung First line option when histology of tumour confirmed as adenocarcinoma or large-cell carcinoma. NICE approved Sept 2009. Forum approved March 2010: Pemetrexed/Carboplatin(NSCLC) Pemetrexed 500mg/m2 IV D1 Carboplatin AUC 5*(Calc CrCl) Inf D1 3/52 Non Small Cell Lung First line option when histology of tumour confirmed as adenocarcinoma or large-cell carcinoma. Forum approved variant on NICE regimen March 2010: Gefitinib Gefitinib 250mg OD PO D1 - 28 4/52 (continuous dosing) Non Small Cell Lung First line option for EGFR mutation positive pts suitable for chemotherapy. NICE approved. Forum approved Nov 2010. Paclitaxel/Carbo Paclitaxel 200mg/m² Inf D1 Carboplatin AUC 6*(Calc CrCl) Inf D1 3/52 Cycle Non Small Cell Lung First line option for treatment of advanced disease. Second choice for adjuvant treatment in pts unsuitable for VinCis (e.g hearing deficit). Non Small Cell Lung Sequential chemo-radiotherapy regimen option for pts unsuitable for VinCis (CCRT) (e.g hearing deficit). NICE endorsed 3/52 Cycle Non Small Cell Lung First line option for advanced stage Regimen of choice for adjuvant treatment. NICE endorsed 3/52 Cycle 2 cycles neoadjuvant followed by 2 cycles concomitant with RT. Non Small Cell Lung Sequential chemo-radiotherapy regimen. NICE endorsed Gemcitabine Gemcitabine 1250mg/m² Inf D1 & 8 3/52 Cycle Non Small Cell Lung Advanced stage Patients unsuitable for platinum regimen NICE endorsed Vinorelbine Vinorelbine 30mg/m2 IV D1 & 8 3/52 Cycle Non Small Cell Lung Advanced stage Patients unsuitable for platinum regimen NICE endorsed *Use AUC 5 if CrCl is measured. *Use AUC 4 if CrCl is measured. *Use AUC 5 if CrCl is measured. Paclitaxel/Carbo (C-CRT) Paclitaxel 200mg/m² Inf D1 Carboplatin AUC 6*(Calc CrCl) Inf D1 *Use AUC 5 if CrCl is measured. Dose reduce during RT to: Paclitaxel 45mg/m2 IV D1,8 & 15 Carboplatin AUC 2 IV D1,8 & 15 Vino/Cis (adjuvant/palliative) Vinorelbine 30mg/m² IV D1 & 8 Cisplatin 80mg/m² Inf D1 3/52 Cycle 2 cycles neoadjuvant followed by 2 cycles concomitant with RT. (Carboplatin AUC 6 may be substituted in elderly patients with poor renal function in palliative cases) Vino/Cis (C-CRT) Vinorelbine 30mg/m² IV D1 & 8 Cisplatin 80mg/m² Inf D1 Dose reduce during RT to: Vinorelbine 15mg/m2 IV D1 & 8 NICE endorsed (Carboplatin AUC 6 calc D1 and AUC 2 D1&8 during RT may be substituted in elderly patients with poor RF) th Last agreed by the Dorset Cancer Network Lung Site Specific Group 27 February 2013. Agreed by Dorset Cancer Network Chemotherapy & Drugs Group on 6 January 2012 (only update since last approval is addition of NICE approval of first line erlotinib). For Review February 2014. Dorset Cancer Network Chemotherapy Regimen Erlotinib Erlotinib 150mg PO OD Last updated Nov 2012 Cycle Length Continuously (Prescribe at 2 wkly intervals for first month, then monthly, then up to two monthly if stable). Docetaxel Docetaxel 75mg/m² Inf D1 3/52 Cycle EP Cisplatin 75mg/m² Inf D1 Etoposide 120mg/m² Inf D1 Etoposide 240mg/m2 PO D2 + 3 3/52 Cycle Setting Non Small Cell Lung First line option for EGFR mutation positive pts suitable for chemotherapy Non Small Cell Lung Second line treatment where Oncologist recommends or patient prefers over chemotherapy. Non Small Cell Lung Advanced stage Second line treatment Small Cell Lung Chemo-radiotherapy regimen of choice. Status NICE approved June 12 (TA 258). Forum approved July 12. NICE approved Nov 08 (TA162). Forum approved June 09. NICE endorsed Standard Dose reduce during RT to: Etoposide 100mg/m2 IV D1 to 3 Carbo/Etop Carboplatin AUC 6* Inf Day 1 3/52 Cycle (AUC 5 if using measured CrCl) Etoposide 120mg/m² Inf D1 Etoposide 240mg/m2 PO D2 + 3 Dose reduce during RT to: Carboplatin AUC 5 Inf D1 Etoposide 100mg/m2 IV D1 to 3 (*Dose increase Carboplatin to AUC 7 calc for radical treatment intent) Small Cell Lung Treatment of choice for extensive disease with PS 0-2 Treatment option for limited stage disease outside of concomitant RT cycles. Option as concomitant RT cycles for patients not suitable for Cisplatin. RT usually given as Turissi regimen with cycle 2 only. Occasionally RT will be given over 2 cycles (non-standard). Total 6 cycles of chemotherapy. Treatment option for PS 3-4 pts who do not wish to lose their hair (Carboplatin alone - drop the etoposide). Small Cell Lung Second line treatment option. Standard Small Cell Lung Treatment for relapsed patients for whom re-treatment with etoposide+platinum is unsuitable, and CAV regimen is contraindicated. Mesothelioma First line treatment of choice. NICE approved Nov 2009. Forum approved March 2010. CAV Cyclophosphamide 750mg/m² IV D1 Doxorubicin 40mg/m² IV D1 Vincristine 2mg D1 3/52 Cycle Standard Topotecan (oral) Topotecan 2.3mg/m² PO D1 to 5 3/52 Cycle Pemetrexed/Cisplatin (Meso) Pemetrexed 500mg/m2 IV D1 Cisplatin 75mg/m2 Inf D1 3/52 Pemetrexed/Carboplatin(Meso) Pemetrexed 500mg/m2 IV D1 Carboplatin AUC 5*(Calc CrCl) Inf D1 3/52 Mesothelioma First line treatment for patients unable to tolerate/unsuitable for cisplatin therapy. Forum approved variant on NICE regimen Oct 08. 3/52 Cycle Thymoma Standard NICE approved January 08. *Use AUC 4 if CrCl is measured. CAP Cyclophosphamide 500mg/m² IV D1 Doxorubicin 50mg/m² IV D1 Cisplatin 50mg/m² Inf D1 th Last agreed by the Dorset Cancer Network Lung Site Specific Group 27 February 2013. Agreed by Dorset Cancer Network Chemotherapy & Drugs Group on 6 January 2012 (only update since last approval is addition of NICE approval of first line erlotinib). For Review February 2014.
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