Chemotherapy of Lung Cancer

Chemotherapy of Lung Cancer 1
CHEMOTHERAPY OF LUNG CANCER
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Chemotherapy of Lung Cancer 2
Chemotherapy of Lung Cancer Case Study
Non-Small Cell Lung Cancer and its Subtypes
Non-small cell lung cancer is a type of lung cancer that arise from the peripheral lung
tissue. Non-small cell lung cancer is a type of lung cancer that develops and spreads rapidly
as compared to Small cell lung cancer (Rosell et al., 2012, p. 242). Non-small cell lung
cancer (NSCLC) is caused by various factors that cause the cells in the lungs to multiply in
an uncontrollable manner. Smoking contributes to 90% of all cases of NSCLC in the world.
The chemical substances in the cigarette smoke increases the risks of tumour growth and
spread in the lung cells. NSCLC is histologically divided into three subtypes.
The first subtype is squamous cell carcinoma which starts from the squamous cells in
the lungs. The squamous cells are the tin and flat cells. It starts from the epithelial cells. The
second subtype is adenocarcinoma which begins form the peripheral tissue of the lungs.
Adenocarcinoma can spread into the lymphatic system, therefore, affecting the lymph. The
tendency to spreads to the lymph nodes causes swelling of the nodes, hence the name
adenocarcinoma. The last subtype of NSCLC is called large cell carcinoma (Kwak et al,
2010, p. 1698). This type of NSCLC may also spread to the lymphatic system and other
distant tissues and cells. Large cell carcinoma is also called undifferentiated and accounts the
least incidences of lung cancer in the world.
Nigel is likely to be suffering from adenocarcinoma because of the signs observed as
a result of his condition. Adenocarcinoma is a subtype that develop and spreads to different
sites of the lungs like alveolus, bronchioles and bronchi (Huiskens et al, 2015, p. 204). The
spread of the cancer cells to these tissues cause congestion in the thoracic region, therefore,
leading to the difficulty in breathing as observed in Nigel. Smoking also causes this subtype
of non-small cell lung cancer. Adenocarcinoma has higher tendency of spreading to other

Chemotherapy of Lung Cancer 3
tissues. In the case scenario, it is also mentioned that Nigel has a stage IV NSCLC, therefore,
it is true to link his condition with adenocarcinoma because stage IV NSCLC also spreads
rapidly like adenocarcinoma.
Nigel’s Secondary Liver Cancer
A secondary is neoplasm that metastasize from the benign lesion. Primary tumours
normally arise from a single tumor cells and metastases from other types of cancers. Nigel’s
lung cancer might have spread to the liver through various metastatic mechanisms. The
primary tumour cells metastasise through the blood stream, direct infiltration to other tissues
and the lymphatic system. The secondary tumour cells are circumscribed and infiltrate
rapidly to the unaffected hepatocytes (Garon et al., 2015, p. 2024). For instance, cancer of the
colon may metastasise and establish itself in the lungs, therefore, causing severe infiltration
in the thoracic cavities. Some of the primary cancers that may metastasise to the liver include
melanoma, colorectal cancer, Ewing sarcoma, Prostate cancer, Breast cancer, and Cancer of
the Thyroid gland but in Nigel’s case, the lung cancer is responsible for the development of
secondary liver cancer. After the spread, lung cancer infiltrates as secondary liver cancer.
Pharmacokinetics and Pharmacodynamics of Cisplatin
Understanding the pharmacological properties of the drug is important in the
chemotherapy of lung cancer. Pharmacokinetic and pharmacodynamics properties are
important in determining the efficacy of the therapeutic agent and selection of the appropriate
route of drug administration. The pharmacokinetic properties of Cisplatin include; higher
plasma concentration, lower drug exposure in the kidney, it is primarily excreted through the
kidney, have higher renal clearance, low binding to plasma proteins, it is 95% bound after 24
hours of administration (Zhou et al., 2011, p. 740). Another important pharmacokinetic
property of Cisplatin is its metabolism in the liver. The drug undergoes First pass metabolism

Chemotherapy of Lung Cancer 4
before its distribution and excretion in the kidneys. The pharmacodynamics focuses on the
effects of the drug to the body. Cisplatin cause toxicity on the liver cells.
Pharmacokinetic and Pharmacodynamics of Docetaxel
The pharmacokinetic properties of Docetaxel are different from the exhibited by
Cisplatin in lung cancer chemotherapy. Docetaxel has a half-life of 10-18 hours. The drug is
absorbed in 70mg/m2 to 112mg/m2. The infusion time is 1 -2 hours. The volume of
distribution of Docetaxel has a slower efflux. The dug is 94% bound to plasma proteins. The
metabolism of Docetaxel is controlled by CYP3A4 isoenzyme present in the liver to produce
four metabolites. The drug is excreted through urine and faeces.
The pharmacodynamics of Docetaxel also determine the efficacy of the
chemotherapeutic process because the effects of the drug on the body are analysed succinctly.
Docetaxel is among the toxoid drugs that work as antineoplastic agents. Docetaxel works by
promoting the assembling of microtubules originating from the tubulin dimers. The drug also
prevents the depolymerization of the microtubules. In this case, the drug interferes with the
mitotic phases of cell division, therefore, preventing tumour cell proliferation.
How Secondary Liver cancer affects the Pharmacokinetics and Pharmacodynamics of
the drugs
Secondary liver cancer affects the normal functioning of the hepatocytes. The effects
may be positive or negative to the drug action. Malignancy of the liver cancer alters with the
functions of the liver in drug metabolism. Metabolism is an important pharmacokinetic
parameter; therefore, its alteration may have negative implications on the bioavailability of
the drug (Bester et al., 2014, p. 342). Both Cisplatin and Docetaxel are metabolized in the
liver; therefore, the secondary liver cancer will affect their efficacy in Nigel's
chemotherapeutic operation.