Lung cancer standard regimens

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.