About lung cancer
The first cause of death in Japan is cancer, among which lung cancer is the largest. About 70,000 people have died in 2012, and the number of lung cancer deaths is increasing year by year. There is smoking as a risk factor for lung cancer, and smoking cessation is the most important to prevent lung cancer. For lung cancer screening, chest X - ray examination for people over 40 years old and sputum cytology for heavy smokers are conducted once a year, and the mortality reduction effect is recognized. In the United States, a large-scale study (NLST: National Lung Screening Trial) was conducted for people with severe smoking between 55 and 74 years old, and the mortality rate of lung cancer in the low dose CT screening group was examined in chest x-ray examination group It was reported that it decreased by 20% in comparison.
Lung cancer can be found by symptoms of lung cancer originally such as cough, sputum, blood sputum, dyspnea, chest pain, or symptoms due to metastasis of lung cancer, such as headache or bone pain, or chest X-ray examination. To confirm the diagnosis of lung cancer, it is necessary to chest CT and then take tissues or cells by bronchoscopy, CT lower lung biopsy, thoracoscopy etc. For the staging diagnosis, we performed an examination of the thoracoabdominal CT, PET (or bone scintigraphy), head MRI, etc., and examined TNM consisting of T (tumor), N (Lymph Node, lymph node), M (Metastasis, metastasis) Clinical stage is decided by classification. Lung cancer is classified as small cell carcinoma (about 15%), adenocarcinoma (about 50%), squamous cell carcinoma (about 30%), large cell carcinoma (several%) depending on the pathological tissue, Small cell lung cancer and non small cell lung cancer (adenocarcinoma, squamous cell carcinoma, large cell carcinoma). Small cell lung cancer uses the classification of localized type (LD: limited disease) where the lesion is confined only to the thorax of the primary lesion side and advanced type (ED: extensive disease) where the tumor is beyond the range of LD Often it is.
Treatment of lung cancer is progressing more than before. Guidelines for lung cancer clinical practice from Nippon Lung Cancer Society are published, updated every year, last year is 2014 version, can be seen by anyone on the Japan Lung Cancer Association website. The 2014 version is also published as a book. For patients and their families, "Japanese Lung Cancer Q & A" is approved by the Japan Society of Lung Cancer and published by the West Japan Cancer Research Organization (WJOG) as a book in 2014.
First of all, it is treatment of small cell lung cancer, but in stage I we will perform adjuvant chemotherapy after surgery plus surgery. For localized small cell lung cancer, chemotherapy and chemoradiotherapy are conducted at the same time as chemotherapy, and for patients who are judged that cancer has almost disappeared (complete remission, CR: complete response), recurrence to the brain is confirmed Radiation therapy (preventive whole-brain radiation) will be performed throughout the brain to prevent it. Evolutionary small cell lung cancer carries
out chemotherapy, but cure is difficult, chemotherapy aims to alleviate symptoms and prolong survival time.
6
If the general condition is bad like PS4 (see Fig. 1), there is no indication for chemotherapy, treatment with palliative care is the main treatment.
Next, treatment of non-small cell lung cancer, but I will perform surgery on stage I, II, resectable stage IIIA. For surgical resection of postoperative pathologic stage IA and IB patients in Japan, oral administration of tegafur / uracil (UFT) was reported to extend survival time compared to surgery alone in Japan It is. For surgical resection of postoperative pathologic stage II and IIIA, it is a report abroad, but surgery is more effective if adjuvant chemotherapy with cisplatin + vinorelbine is performed after surgery. In stage III which can not be resected, radiation therapy is performed with chemotherapy and radiation therapy.
I will do chemotherapy at stage III and stage IV for curative irradiation. Cure is difficult, chemotherapy aims to relieve symptoms and prolong survival. Currently non-squamous cell carcinoma is examined for EGFR (Epidermal growth factor receptor) gene mutation, ALK (Anaplastic lymphoma kinase) gene translocation, and if it is positive, we will administer molecular targeted drugs. There are three kinds of molecular targeting drugs such as gefitinib, erlotinib, and afatinib in the EGFR gene mutation positive, and a significant prolongation of progression free survival time is recognized in primary treatment as compared with cytotoxic anticancer drug. At ALK gene translocation positive there are two types of molecular targeted drugs such as crizotinib and alectectinib. Currently, crizotinib shows a significant prolongation of progression-free survival as compared with cytotoxic anticancer agent in primary treatment It is. For EGFR gene mutation negative in non-squamous cell carcinoma, in combination with platinum preparations and third generation anticancer drugs developed after the 1990s when ALK gene translocation is negative. In addition, bevacizumab, an angiogenesis inhibitor, may be used in combination with three drugs. Recently, there is a method called "maintenance therapy" that chemotherapy is continued to the first chemotherapy, chemotherapy with pemetrexed is continued unless the cancer is worse after 4 courses of cisplatin + pemetrexed combination therapy and there is no problem in side effects I will. For squamous cell carcinoma, we will use platinum formulation together with third generation anticancer drugs.
Currently, patients with PS3-4 (see Fig. 1) are non-small cell carcinoma EGFR gene mutation negative, ALK gene translocation negative, there is no indication for chemotherapy, treatment for palliative care main subject. However, in the future, there is a possibility that molecular targeted drugs targeting other than EGFR gene mutation positive and ALK gene translocation positive will come out and become able to be treated.
Cisplatin, a platinum formulation, has side effects such as vomiting, nausea, and kidney injury, but it is a key drag of chemotherapy for lung cancer. There is a report that the extent of renal impairment becomes lighter by adding magnesium, and cisplatin short hydration that infuses a small amount in a short time are reported. There are reports of two clinical trials positively evaluating the safety of short hydration in the TRIPLE test showing the effectiveness of 3 antiemetic therapies in combination with advanced emetogenic chemotherapy in Japan, due to the progress of antiemetic drugs and short hydration , Cisplatin combination chemotherapy for patients with lung cancer has become outpatient treatment possible. This hospital is a hospitalization therapy, but in February 2014 we introduced a short hydration that added magnesium, and in January 2011 I compared the toxicity in combination chemotherapy with cisplatin (≥ 60 mg / m 2). Shows cisplatin (CDDP) plus pemetrexed (PEM) short hydration
On the other hand, with short hydration, fever neutropenia decreased in one patient with Grade 3 and no increase in creatinine was observed. In short hydration, we could safely enforce without increasing creatinine. Prior to administration of cisplatin, chemotherapy is performed with general condition, kidney function, cardiac function (electrocardiogram, echocardiogram, BNP), but 3 cases with atrial fibrillation was confirmed in the conventional regimen. There was a report that atrial fibrillation developed due to cisplatin administration, it was possible to appear also in short hydration, I thought that checking of symptoms such as palpitations and electrocardiogram is necessary. We plan to verify kidney function, cardiac function, etc. by carrying out cisplatin short hydration in the future. At present, cisplatin + S1 is also spreading in outpatient treatment for stomach cancer. Recently, cisplatin short hydration has been carried out at the outpatient chemotherapy center, and we hope to increase the number of introductions and contribute to the improvement of QOL of cancer patients.
The first cause of death in Japan is cancer, among which lung cancer is the largest. About 70,000 people have died in 2012, and the number of lung cancer deaths is increasing year by year. There is smoking as a risk factor for lung cancer, and smoking cessation is the most important to prevent lung cancer. For lung cancer screening, chest X - ray examination for people over 40 years old and sputum cytology for heavy smokers are conducted once a year, and the mortality reduction effect is recognized. In the United States, a large-scale study (NLST: National Lung Screening Trial) was conducted for people with severe smoking between 55 and 74 years old, and the mortality rate of lung cancer in the low dose CT screening group was examined in chest x-ray examination group It was reported that it decreased by 20% in comparison.
Lung cancer can be found by symptoms of lung cancer originally such as cough, sputum, blood sputum, dyspnea, chest pain, or symptoms due to metastasis of lung cancer, such as headache or bone pain, or chest X-ray examination. To confirm the diagnosis of lung cancer, it is necessary to chest CT and then take tissues or cells by bronchoscopy, CT lower lung biopsy, thoracoscopy etc. For the staging diagnosis, we performed an examination of the thoracoabdominal CT, PET (or bone scintigraphy), head MRI, etc., and examined TNM consisting of T (tumor), N (Lymph Node, lymph node), M (Metastasis, metastasis) Clinical stage is decided by classification. Lung cancer is classified as small cell carcinoma (about 15%), adenocarcinoma (about 50%), squamous cell carcinoma (about 30%), large cell carcinoma (several%) depending on the pathological tissue, Small cell lung cancer and non small cell lung cancer (adenocarcinoma, squamous cell carcinoma, large cell carcinoma). Small cell lung cancer uses the classification of localized type (LD: limited disease) where the lesion is confined only to the thorax of the primary lesion side and advanced type (ED: extensive disease) where the tumor is beyond the range of LD Often it is.
Treatment of lung cancer is progressing more than before. Guidelines for lung cancer clinical practice from Nippon Lung Cancer Society are published, updated every year, last year is 2014 version, can be seen by anyone on the Japan Lung Cancer Association website. The 2014 version is also published as a book. For patients and their families, "Japanese Lung Cancer Q & A" is approved by the Japan Society of Lung Cancer and published by the West Japan Cancer Research Organization (WJOG) as a book in 2014.
First of all, it is treatment of small cell lung cancer, but in stage I we will perform adjuvant chemotherapy after surgery plus surgery. For localized small cell lung cancer, chemotherapy and chemoradiotherapy are conducted at the same time as chemotherapy, and for patients who are judged that cancer has almost disappeared (complete remission, CR: complete response), recurrence to the brain is confirmed Radiation therapy (preventive whole-brain radiation) will be performed throughout the brain to prevent it. Evolutionary small cell lung cancer carries
out chemotherapy, but cure is difficult, chemotherapy aims to alleviate symptoms and prolong survival time.
6
If the general condition is bad like PS4 (see Fig. 1), there is no indication for chemotherapy, treatment with palliative care is the main treatment.
Next, treatment of non-small cell lung cancer, but I will perform surgery on stage I, II, resectable stage IIIA. For surgical resection of postoperative pathologic stage IA and IB patients in Japan, oral administration of tegafur / uracil (UFT) was reported to extend survival time compared to surgery alone in Japan It is. For surgical resection of postoperative pathologic stage II and IIIA, it is a report abroad, but surgery is more effective if adjuvant chemotherapy with cisplatin + vinorelbine is performed after surgery. In stage III which can not be resected, radiation therapy is performed with chemotherapy and radiation therapy.
I will do chemotherapy at stage III and stage IV for curative irradiation. Cure is difficult, chemotherapy aims to relieve symptoms and prolong survival. Currently non-squamous cell carcinoma is examined for EGFR (Epidermal growth factor receptor) gene mutation, ALK (Anaplastic lymphoma kinase) gene translocation, and if it is positive, we will administer molecular targeted drugs. There are three kinds of molecular targeting drugs such as gefitinib, erlotinib, and afatinib in the EGFR gene mutation positive, and a significant prolongation of progression free survival time is recognized in primary treatment as compared with cytotoxic anticancer drug. At ALK gene translocation positive there are two types of molecular targeted drugs such as crizotinib and alectectinib. Currently, crizotinib shows a significant prolongation of progression-free survival as compared with cytotoxic anticancer agent in primary treatment It is. For EGFR gene mutation negative in non-squamous cell carcinoma, in combination with platinum preparations and third generation anticancer drugs developed after the 1990s when ALK gene translocation is negative. In addition, bevacizumab, an angiogenesis inhibitor, may be used in combination with three drugs. Recently, there is a method called "maintenance therapy" that chemotherapy is continued to the first chemotherapy, chemotherapy with pemetrexed is continued unless the cancer is worse after 4 courses of cisplatin + pemetrexed combination therapy and there is no problem in side effects I will. For squamous cell carcinoma, we will use platinum formulation together with third generation anticancer drugs.
Currently, patients with PS3-4 (see Fig. 1) are non-small cell carcinoma EGFR gene mutation negative, ALK gene translocation negative, there is no indication for chemotherapy, treatment for palliative care main subject. However, in the future, there is a possibility that molecular targeted drugs targeting other than EGFR gene mutation positive and ALK gene translocation positive will come out and become able to be treated.
Cisplatin, a platinum formulation, has side effects such as vomiting, nausea, and kidney injury, but it is a key drag of chemotherapy for lung cancer. There is a report that the extent of renal impairment becomes lighter by adding magnesium, and cisplatin short hydration that infuses a small amount in a short time are reported. There are reports of two clinical trials positively evaluating the safety of short hydration in the TRIPLE test showing the effectiveness of 3 antiemetic therapies in combination with advanced emetogenic chemotherapy in Japan, due to the progress of antiemetic drugs and short hydration , Cisplatin combination chemotherapy for patients with lung cancer has become outpatient treatment possible. This hospital is a hospitalization therapy, but in February 2014 we introduced a short hydration that added magnesium, and in January 2011 I compared the toxicity in combination chemotherapy with cisplatin (≥ 60 mg / m 2). Shows cisplatin (CDDP) plus pemetrexed (PEM) short hydration
On the other hand, with short hydration, fever neutropenia decreased in one patient with Grade 3 and no increase in creatinine was observed. In short hydration, we could safely enforce without increasing creatinine. Prior to administration of cisplatin, chemotherapy is performed with general condition, kidney function, cardiac function (electrocardiogram, echocardiogram, BNP), but 3 cases with atrial fibrillation was confirmed in the conventional regimen. There was a report that atrial fibrillation developed due to cisplatin administration, it was possible to appear also in short hydration, I thought that checking of symptoms such as palpitations and electrocardiogram is necessary. We plan to verify kidney function, cardiac function, etc. by carrying out cisplatin short hydration in the future. At present, cisplatin + S1 is also spreading in outpatient treatment for stomach cancer. Recently, cisplatin short hydration has been carried out at the outpatient chemotherapy center, and we hope to increase the number of introductions and contribute to the improvement of QOL of cancer patients.
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