Pancoast Syndrome Medication

Updated: Nov 03, 2022
  • Author: Karl J D'Silva, MD; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Medication Summary

The goals of pharmacotherapy for Pancoast tumor are to induce remission, reduce morbidity, and prevent complications. Chemotherapy is typically part of multimodal treatment that also includes surgery and radiation therapy.


Antineoplastics, Other

Class Summary

Antineoplastic agents inhibit cell growth and proliferation. They are used to treat the following conditions:

- Head, neck, breast, testicular, and ovarian cancer

- Hodgkin and non-Hodgkin lymphoma

- Neuroblastoma

- Sarcomas

- Bladder, gastric, lung, esophageal, cervical, and prostate cancer

- Myeloma

- Melanoma

- Mesothelioma

- Small cell lung cancer (SCLC)

- Osteosarcoma

- Acute nonlymphoblastic leukemia

- Hepatoma

- Rhabdomyosarcoma, mycosis fungoides, uterine carcinoma, and histiocytosis

- Gestational trophoblastic disease

- Ewing sarcoma, Kaposi sarcoma, Wilms tumor, and brain tumors

Cisplatin (Platinol)

Cisplatin is an alkylating agent that causes intrastrand and interstrand cross-linking of DNA, leading to strand breakage. It has broad range of antitumor activity and forms the backbone of currently available approved combination chemotherapy regimens for SCLC and non-SCLC (NSCLC) that cause Pancoast syndrome.

Cisplatin is administered by intravenous infusion in isotonic sodium chloride solution (0.9%) or sodium chloride and glucose. The manufacturers recommend that higher doses be administered in 2 L of chloride-containing infusion fluid over at least 1-2 hours and that an infusion time of 6-8 hours may further reduce toxicity. In practice, volumes of less than 2 L have been used in expert centers.

To aid diuresis and protect the kidneys, 37.5 g of mannitol (eg, 375 mL [10%]) is usually added to the infusion, or is infused separately, immediately before cisplatin. To initiate diuresis, the patient is usually hydrated by the infusion of 1-2 L of a suitable fluid over several hours before the administration of cisplatin. Adequate hydration must also be maintained for up to 24 hours after a dose. Renal, hematologic, auditory, and neurologic function should be monitored during therapy and administration adjusted accordingly.

Etoposide (Toposar)

Etoposide is a semisynthetic derivative of podophyllotoxin with antineoplastic properties; it interferes with the function of topoisomerase II, thus inhibiting DNA synthesis, and is most active against cells in the late S and G(2) phases of the cell cycle.