Accurate staging of non-small cell lung (NSCLC) cancer is essential before definitive therapy can begin. Staging is performed according to the tumor, node, metastasis (TNM), staging system. Select the following general stage of cancer in order to learn more about treatment options. In addition to stage other tests may be performed on the biopsy in order to further classify the cancer and determine the optimal treatment strategy. Based on the stage of the cancer and the results of these tests, treatment of lung cancer is individualized.
Testing the cancer for specific characteristics: An important advance in the treatment of NSCLC is the development of targeted therapies—drugs that target specific biological pathways involved in the growth or spread of cancer. Patients should endure that their cancer is teste in order to determine the best overall treatment strategy.
EGFR gene: Mutations in the epidermal growth factor receptor (EGFR) gene may affect how NSCLC responds to certain drugs. EGFR contributes to the growth of several types of cancer, and drugs that block the activity of EGFR can slow cancer growth. One EGFR-targeted drug that has been shown to benefit selected patients with NSCLC is Tarceva® (erlotinib). Tarceva is currently approved for the treatment of advanced NSCLC and as maintenance therapy after chemotherapy.1,2
ALK gene: Up to 7% of NSCLC have an abnormal version of the ALK gene that contributes to the growth and development of cancer cells. Xalkori™ (crizotinib) is an oral medication that blocks certain proteins, including the protein produced by this abnormal gene. For advanced NSCLC that test positive for the ALK gene abnormality, Xalkori has produced very promising rates of response.3
Stage I: The cancer measures 5 centimeters or smaller and does not involve the lymph nodes.
Stage II: The cancer has not spread to the lymph nodes but is larger than 5 centimeters or involves structures near the lung such as the chest wall or diaphragm. NSCLC is also considered to be Stage II if it measures 7 centimeters or less and involves the lymph nodes within the lung or near the bronchus.
Stage IIIA: The cancer involves lymph nodes in the space between the lungs (mediastinum) or near where the windpipe divides; is large or extensive but the only lymph node involvement is within the lung or near the bronchus; or there is no lymph node involvement but the cancer extends to other organs or tissues such as the heart, great vessels, trachea, or other lobes of the lung.
Stage IIIB:: The cancer involves lymph nodes on the opposite side of the chest or above the collar bone, or is extensive (involves organs such as the heart or trachea) and also involves lymph nodes in the center of the chest (mediastinum) or near where the windpipe divides.
Stage IV: Cancer is found in both lungs, in the fluid that surrounds the lungs or heart, or has spread to other parts of the body such as the liver, brain, or bones.
Recurrent/Relapsed: Cancer has progressed or returned (recurred/relapsed) following an initial treatment with surgery, radiation therapy and/or chemotherapy.
Cappuzo F, Ciuleanu T, Stelmakh L, et al. Erlotinib as maintenance treatment in advanced non-small-cell lung cancer: A multi-center, randomized, placebo-controlled phase 3 study. The Lancet Oncology. Published early online May 20, 2010.
2 Zhou C, Wu Y-L, Chen G et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): A multicentre, open-label, randomized, phase 3 study. Lancet Oncology. Early online publication July 22, 2011.
3 Shaw AT, Kim DW, Mehra R, et al: Ceritinib in ALK-rearranged non–small-cell lung cancer. New England Journal of Medicine. 2014; 370: 1189-1197.