Only in severe cases of these toxicities, for
example when the patient becomes dehydrated
due to diarrhoea or the skin rash becomes very
infected or too severe for the patient to tolerate,
should therapy be discontinued for a period
of time then recommenced at a lower dose.
However, this should only be done following the
advice of the treating oncologist or clinical nurse
specialist (McPhelim et al 2011).
Other advances in therapy for patients
with NSCLC include chemotherapy
regimens dependent on histological subtype,
chemotherapy either before surgery in an
attempt to downstage a cancer or following
surgery to increase the chance of five-year
survival, and maintenance chemotherapy for
patients who have had a good response or
who have stable disease following first-line
chemotherapy (Lee 2010). There are also more
options for second and third-line therapies
using either a different tyrosine kinase inhibitor
or chemotherapy regimen (Califano 2009,
D’Addario et al 2010, Leighl 2012).
Brain metastases are common in patients
with lung cancer; for some it is the presenting
symptom, but for others it develops later in the
disease pathway (Mulvenna and Langley 2009).
Previously, whole brain radiotherapy would
be offered often to patients who responded
well to dexamethasone, however there is no
empirical evidence to suggest that this is the most