ChemoTherapy & Targeted Biological Therapy

Systemic treatments are widely used for both Small Cell and Non Small Cell Lung Cancers.  Systemic treatments are those that are administered to the whole body (intravenously or orally) with the expectation that the active drug will be carried by the blood stream to all potential areas of cancer involvement.  Systemic treatments can involve chemotherapy or a new class of agents called targeted or biological therapy.  The primary difference is that chemotherapy attempts to kill any actively dividing cell whether it is cancerous or not.  Biological agents have an in built targeting mechanism that restricts its activity to a smaller sub class of cells that include the type of lung cancer that a particular patient has.

 Various combinations of chemotherapy and targeted therapies are used depending on the situation.  Stage by stage recommendations are best discussed with your medical oncologist.  Common agents used in lung cancer are reviewed below.

COMMON CHEMOTHERAPY AGENTS FOR LUNG CANCER:

Platinum Based Agents:

The two common platinum drugs used are Cisplatinum and Carboplatinum.  They work by binding adjacent DNA strands to each other.  The DNA strands then become dysfunctional and this eventually leads to the death of the cell.

Central line

Central line

Cisplatinum and Carboplatinum are by far the most common agents used in both Small Cell and Non-Small Cell Lung cancers.  They are both administered intravenously through a central line to decrease the chance of irritation of the vein.  One of these two agents is usually combined with another chemotherapeutic drug in a particular treatment regimen.  Sometimes one of these agents can be used alone in settings such as stage IV cancer.  The chemotherapy can also be combined with one of the biological agents described below.

Taxane Chemotherapy:

Taxol Rizwan Nurani

This is the second most common class of chemotherapy used for lung cancer.  Paclitaxel (Taxol) interferes with cells that are dividing.  When a cancer cell divides to make daughter cells, it requires a transport mechanism, called microtubules, to equally move the DNA into the two new cells.   Taxol stops this microtubule facilitated DNA transport and thus causes the death of the cells.  

Pemetrexed (Alimta):

Pemetrexed is a chemotherapy that works by not allowing new DNA to be formed in the dividing cells.

Additional Chemotherapy agents used for lung cancer include:

  • Vinorelbine
  • Gemcitabine
  • Irinotecan
  • Etoposide 

COMMON TARGETED (BIOLOGIC) THERAPY FOR LUNG CANCER: 

Bevacizumab (Avastin) is a antibody therapy that binds to and prevents the functioning of a molecule called vascular endothelial growth factor (VEGF).  This prevents the cancer from forming new blood vessels to support its growth.  It is frequently used in combination with a chemotherapy regimen in the setting of the adenocarcinoma type of Non-Small Cell Lung Cancers. 

anti-vegf

Cetuximab (Erbitux) is a antibody therapy that targets a molecule called epidermal growth factor receptor (EGFR).  It prevents the functioning of EGFR which is one of the ways cancer cells stimulate themselves to grow. Thus, if a particular cancer has a large amount of EGFR, Cetuximab is used in addition to a traditional chemotherapy regimen. 

Erlotinib (Tarceva) and Gefitnib (Iressa) are tyrosine kinase inhibitors.  These molecules also affect the functioning of epidermal growth factor receptors through a pathway that is different then cetuximab.  In patients whose cancers have a particular DNA mutation in EGFR, these agents are particularly useful.  In fact when the cancer is Stage IV, these agents can be used first before chemotherapy is considered.

© Rizwan Nurani 2012