Currently, the improvement of the results of treatment of small and non-small cell
lung cancer is promoted by high-dose polychemotherapy, including with
the use of new chemotherapy drugs.
Monochemotherapy is practically only used in cases of malignant
pleurisy. Polychemotherapy is carried out according to the schemes, including a combination of 2—
drugs.
The use of repeated courses of chemotherapy according to the same schemes
it is advisable if after the first courses were received
objective effect.
Long-term results suggest that combination treatment with
subsequent polychemotherapy cyclophosphamide, 5-fluorouracil and methotrexate
helps to increase the five-year survival of patients with squamous cancer
lung stage III compared with only surgical treatment. More often
The positive effect of adjuvant therapy is noted at the tumor, corresponding to
T 3, with the defeat of bronchopulmonary and root lymph nodes without metastases in
mediastinum. Improving long-term results of combined treatment of patients
stage III lung cancer is achieved under the condition of not
less than 3 courses of postoperative polychemotherapy.
Improving the results of the combined treatment of patients with lung cancer III
stage, which was held postoperative chemotherapy associated with
a decrease in the frequency of distant metastasis. Usually, postoperative chemotherapy is performed with cyclophosphamide,
5-fluorouracil, metatrexate. Due to differences in sensitivity to
chemotherapy in different patients when choosing tactics of treatment take into account such
prognostic features such as gender, patient age, location and size
primary tumor, its histological variant and degree of differentiation, stage
process.
When conducting polychemotherapy in patients with small cell lung cancer
along with the above drugs use nitrosomethylurea,
CCNU, adriablastin, cisplatin, vincristine, natulan, etoposide.
Currently undergoing clinical trials of a new chemotherapy drug,
derived from the bark of the Pacific yew-taxol (paclitaxel). The mechanism of it
actions associated with mitosis suppression due to impaired normal function
microtubules of the mitotic spindle. It was originally proposed for treatment
metastatic ovarian carcinoma. Its close structural counterpart Taxotere
synthesized on the basis of a substance extracted from European yew needles. Already
promising results of using this drug in the treatment of
lung cancer patients. At the conclusion of the Western Cooperative Cancer
group (USA) taxol can be considered as the most active at present
monochemical agent in stage IV non-small cell lung cancer (21—%
remission). Paclitaxel (taxol manufactured by Bristol-Myers Squibb)
allowed for clinical use in Russia. Studies show
equally high response when combining taxol with cisplatin or carboplatin.
A new semi-synthetic drug from the group of vinca alcoloids was obtained –
vinorelbine (navelbin). It has a cytostatic effect associated with
by inhibiting tubulin polymerization during cell mitosis. Applied
in mono- and polychemotherapy of non-small cell lung cancer.
Interest in the previously known drug etoposide has renewed. Inclusion
etoposide in combination chemotherapy programs improves treatment outcomes
patients with small cell lung cancer (in combination with cisplatin and
carboplatin).
Changing the modes and methods of using cytostatics also contributes
increase the immediate results of treatment of small and non-small cell lung cancer
lung, in particular, holding high-dose and varying intensity
combination chemotherapy with hematopoietic colon-stimulating
factors (combination with cisplatin or carboplatin, etoposide,
doxorubicin or epirubicin, vincristine, etc.).
The most interesting in recent years, the so-called neoadjuvant
or induction chemotherapy, which is carried out before the main treatment
(surgical or radial). The use of such chemotherapy is justified.
the possibility of using high doses of cytostatics, a significant decrease in
tumor volume before surgery or radiation, the best penetration
chemotherapy drugs in a tumor still intact and rapid and early destruction
possible micrometastases.
However, the use of high-dose polychemotherapy may lead to a delay in
or even refusal from the main treatment, perhaps even the formation of clones of cells
resistant to further treatment with cytostatics and radiation. Currently
accumulated a lot of data from research on this issue, but
Nevertheless the follow-up dates are not so long as to draw final conclusions. The following regimens are used for polychemotherapy in patients with non-small cell lung cancer: CAMP — cyclophosphamide 300 mg / m 2 intravenously on days 1 and 8, adriamycin 20–25 mg / m 2 per 1 th and 8th days, methotrexate 15 mg / m 2 intravenously on the 1st and 8th days of the cycle, procarbazine (natulan) 100 mg / m 2 orally from the 1st to the 10th day. The cycles are repeated at 4-week intervals. VP-P is etoposide (vepezid) 120 mg / m 2 intravenously at 1, 3 and 5 days, cisplatin 60 mg / m 2 intravenously at 1 day. The treatment courses are repeated after 4 weeks. CAV — cyclophosphane 500 mg / m 2 intravenously on day 1, adriamycin 50 mg / m 2 intravenously on day 1, vincristine 1.4 mg / m 2 intravenously on day 1. The courses of treatment are repeated after 4 weeks. MACC — methotrexate 30-40 mg / m 2 intravenously on day 1, adriamycin 30— mg / m 2 intravenously on day 1, cyclophosphamide 400 mg / m 2 intravenously on day 1, CCNU30 mg / m 2 orally on the 1st day. courses of treatment are repeated after 3–7 weeks. CAP — cyclophosphane 400–500 mg / m 2 intravenously on the 1st day, adriamycin 40– mg / m 2 intravenously, on the 1st day, cisplatin 40–50 mg / m 2 intravenously 1st day The treatment courses are repeated after 4 weeks. FAM —Fluorouracil 600 mg / m 2 intravenously at days 1, 8, 29 and 36, adriamycin 30 mg / m 2 intravenously at days 1 and 29, mitomycin C 10 mg / m 2 intravenous drip in the 1st day. Courses are repeated from the 56th day from the start of treatment. MVP — mitomycin C 10 mg / m 2 intravenously on the 1st day, vinblastine 5 mg / m 2 intravenously on the 1st and 8th days, cisplatin 100 mg / m 2 intravenous drip in the 1st day. The treatment courses are repeated after 4 weeks. Ifosfamide 2 mg / m 2 intravenously from day 1 to day 5, cisplatin 75 mg / m 2 intravenously drip for 1 day. Repeated courses of treatment every 4 weeks. PCVP — prospidin 120 mg / m 2 intravenously or intramuscularly 3 times a week — 10 administrations, cyclophosphamide 300 mg / m 2 intramuscularly 3 times a week — 10 administrations, vincristine 1.4 mg / m 2 intravenously 1, 8, 15 and 22nd days, prednisone 25— mg per day in the course of the entire course. Break 6 weeks, if the course exceeds 3 weeks. When conducting chemotherapy for patients with small cell lung cancer, use the following regimens: CAM — Cyclophosphamide 1500 mg / m 2 intravenously on day 1, adriamycin 60 mg / m 2 intravenously on day 1, methotrexate 30 mg / m 2 intravenously on the 1st day. The treatments are repeated every 28 days. CAV — cyclophosphane 1500 mg / m 2 intravenously on day 1, adriamycin 60 mg / m 2 intravenously on day 1, vincristine 1.4 mg / m 2 intravenously on day 1. The courses are repeated every 28 days. CMC-VAP — cyclophosphane 1500 mg / m 2 intravenously on the 1st day and 1000 mg / m 2 intravenously on the 22nd day, methotrexate 15 mg / m 2 orally at 1, 4, 8, 11, 15, 22,29 and 32 days, CCNU 100 mg / m 2 orally on the 1st day, vincristine 1.4 mg / m 2 intravenously in the 42nd and 63rd days, adriamycin 60 mg / m 2 intravenously The 42nd and 63rd days, procarbazin100 mg / m 2 orally from the 42nd to the 51st and from 6 the 3rd to the 72nd day. The treatment courses are repeated after 2 weeks, 2— times.ACE. —Adriamycin 45 mg / m 2 intravenously on the 1st day, cyclophosphane 1000 mg / m 2 intravenously on the 1st day, etoposide (vepezid) 50 mg / m 2 intravenously drip from the 1st on the 5th day. The treatment courses are repeated after 3 weeks at least 3 times. CAVE — cyclophosphane 1000 mg / m 2 intravenously on the 1st day, adriamycin40 mg / m 2 intravenously on the 1st day, vincristine 2 mg / m 2 intravenously on the 1st day , etoposide (vepezid) 50 mg / m 2 intravenously from the 1st to the 5th day. The treatment courses are repeated after 3 weeks.VP-P — etoposide (vepezid) 100 mg / m 2 intravenously at 2, 3, 4, 5, and 6th day, cisplatin 100 mg / m 2 intravenously at 1 day. The treatment courses are repeated after 3 weeks. VP-CBDCA — etoposide (vepezid) 100 mg / m 2 intravenously on days 1, 2 and 3, carboplatin 300 mg / m 2 intravenously on day 1. Repeated courses after 28 days. There are different opinions about the sequence of application of radiation and chemotherapy for chemoradiation treatment of common forms of cancer light. In the case of radiation in the traditional mode of fractionation, the duration of the first stage of treatment is about 5 weeks. In such a case, it is necessary to begin treatment with chemotherapy. Preference is given to radiation therapy, carried out in nontraditional regimens, leading to a tumor for 2 weeks high, about 60 Gy, doses. Radiation is well tolerated by patients, which determines the possibility of polychemotherapy.