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Systemic therapy for the initial management of advanced non-small cell lung cancer without a driver mutation

Author
Rogerio C Lilenbaum, MD, FACP
Section Editor
James R Jett, MD
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

Treatment of patients with lung cancer depends upon the tumor stage, histology (non-small cell lung cancer [NSCLC] versus small cell lung cancer, nonsquamous versus squamous NSCLC), molecular characteristics, and an assessment of the patient's overall medical condition. (See "Overview of the initial evaluation, treatment and prognosis of lung cancer".)

Patients with stage I, II, or III NSCLC (table 1) are generally treated with curative intent using surgery, chemotherapy, radiation therapy (RT), or a combined modality approach. In contrast, palliative systemic therapy is the primary approach for patients with stage IV disease. Palliative systemic therapy is also used for patients who have relapsed with advanced disease following prior definitive treatment.

For patients without a driver mutation, systemic treatment generally consists of cytotoxic chemotherapy using a cisplatin or carboplatin based doublet. Combinations of chemotherapy with bevacizumab, a monoclonal antibody that binds vascular endothelial growth factor (VEGF), are often used in patients with adenocarcinoma. Maintenance treatment, using components of the initial regimen or another non-cross resistant agent, is often included as part of the treatment and continued until progressive disease develops or toxicity requires cessation of therapy.

The issues surrounding the choice of the initial regimen, including maintenance therapy, are discussed in this topic. The overall approach to the treatment of advanced NSCLC, the role of personalized therapy based upon specific driver mutations, treatment of elderly and poor performance status patients, and issues surrounding therapy once progressive disease has developed are discussed separately.

(See "Overview of the treatment of advanced non-small cell lung cancer".)

                                   

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 22 00:00:00 GMT+00:00 2016.
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