Treatment options for non-small cell lung cancer
Treatment options for people with non-small cell lung cancer (NSCLC) include surgery, radiation therapy, chemotherapy, targeted drug therapies and other local treatments. Depending on your treatment regimen, you may see different types of doctors who specialize in those areas1:
Surgery is an option for early-stage lung cancer and the best chance for cure, however, patients must be healthy enough for surgery. Types of lung surgery include:
- Pneumonectomy (entire lung removed)
- Lobectomy (entire section, lobe, of a lung is removed)
- Segmentectomy or wedge resection (part of a lobe is removed)
- Sleeve resection - May be done to treat cancers in large airways in the lungs. Nearby lymph nodes are also removed to look for possible spread of the cancer. This is a major operation that can take weeks to months for recovery, with limited activity. Serious complications may include excess bleeding, wound infections, and pneumonia.
If a patient can’t have major surgery due to other medical issues or the cancer has spread too far, surgery may be used to treat fluid build-up or relieve blocked airways. Pleurodesis, or catheter placement, is a procedure to help drain fluids. Laser therapy or photodynamic therapy can be used to relieve blockage in the airway or a bronchoscope can be used to place a stent in the airway to keep it open.
External beam radiation therapy targets your lung cancer. Newer types of radiation therapy include:
- Three-dimensional conformal radiation therapy (3D-CRT): 3D-CRT uses special computers to precisely map the location of the tumor(s). Radiation beams are shaped and aimed at the tumor(s) from several directions, which makes it less likely to damage normal tissues.
- Intensity modulated radiation therapy (IMRT): IMRT is an advanced form of 3D therapy. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the tumor from several angles, the intensity (strength) of the beams can be adjusted to limit the dose reaching the most sensitive normal tissues. This technique is used most often if tumors are near important structures such as the spinal cord. Many major hospitals and cancer centers now use IMRT.
- Stereotactic body radiation therapy (SBRT): SBRT, also known as stereotactic ablative radiotherapy (SABR), is sometimes used to treat very early stage lung cancers when surgery isn’t an option due to issues with the patient’s health or in patients who do not want surgery.
Conventional radiation therapy is used less often today if the above advanced methods are available.
Internal radiation or brachytherapy is the placement of radioactive material (in form of small pellets or “seeds”) into or near your tumor. For lung cancer, it is used to shrink tumors in the airway to relieve symptoms. The radiation travels only a short distance from the source, limiting the effects on surrounding healthy tissues. It is removed after a short time or may be left in permanently while the radiation weakens over time.
Side effects of brachytherapy can include sunburn-like skin problems, hair loss at point of radiation entry, fatigue, nausea/vomiting, loss of appetite, weight loss. These side effects often go away after radiation treatment is done. They may be worse if radiation is combined with chemotherapy.
Chemotherapy for non-small cell lung cancer
Chemotherapy (chemo) is treatment with anti-cancer drugs injected into a vein or taken by mouth. Chemo may be used before surgery, after surgery, or as a main treatment. Chemo is given in cycles, with a period of rest time in between to let the body recover. Most often, chemo treatment uses a combination of two chemo drugs. If a combination is used, it often includes either cisplatin or carboplatin plus one other drug. Targeted drug therapies may be given for people with more advanced cancers2.
Chemo drugs used often for NSCLS include:
- Paclitaxel (Taxol®)
- Albumin-bound paclitaxel (nab-paclitaxel, Abraxane®)
- Docetaxel (Taxotere®)
- Gemcitabine (Gemzar®)
- Vinorelbine (Navelbine®)
- Irinotecan (Camptosar®)
- Etoposide (VP-16®)
- Pemetrexed (Alimta®)
Possible side effects include hair loss, mouth sores, loss of appetite, nausea/vomiting, diarrhea or constipation, increased chance of infections, easy bruising or bleeding, and fatigue. Some drugs have specific side effects. Side effects are usually short-term and go away.
Some newer drugs specifically target changes in lung cancer, and work differently than traditional chemo drugs. They may work when chemo drugs don’t and often have less severe side effects. These drugs are most often used for advanced lung cancer. Drugs may be taken daily as pills, or given by IV infusion3.
Drugs that target tumor blood vessel growth. Tumors must form new blood vessels to grow, in a process called angiogenesis. Targeted drugs block the new blood vessel growth.
Drugs that target epidermal growth factor receptor (EGFR). EGFR is a protein found on the surface of cells that helps them grow and divide. Some NSCLC cells have too much EFGR, which causes rapid growth.
- Erlotinib (Tarceva®)
- Cetuximab (Erbitux®)
- Afatinib (Gilotrif™)
Drugs that target the ALK gene – 5% of NSCLCs have a rearrangement of a gene called ALK, particularly people who were non-smokers or light smokers who have the adenocarcinoma subtype. The rearrangement causes abnormal ALK protein that cases cells to grow and spread.
Other treatments may be used for non-small cell lung cancer at specific locations in the body. Radiofrequency ablation (RFA), photodynamic therapy, laser therapy and stent placement are local treatment options4.
- Radiofrequency ablation (RFA) – Option for people who can’t or don’t want to have surgery. It uses high-energy radio waves to heat the tumor through a probe placed in the skin. The heat destroys the tumor. It is an outpatient procedure using local anesthesia; complications are rare.
- Photodynamic therapy (PDT) – Used to treat very early stages of lung cancer or help open airways blocked by tumors. A light-activated drug called porfimer sodium (Photofrin®) is injected into a vein. The drug is more likely to collect in cancer cells. After a few days a bronchoscope is passed down the throat and into the lung with aid of local anesthesia or general sedation. A laser light on the end of the bronchoscope activates the drug and causes the tumor cells to die. Dead cells are then removed a few days later.
- Laser therapy - Sometimes used to treat very small lung cancers in the linings of airways. Lasers can also be used to help open up airways blocked by larger tumors to help people breathe better. Under anesthesia, a bronchoscope is passed down the throat next to the tumor. A laser beam is aimed at the tumor to burn it away.
- Stent placement – Used to help keep airways open to alleviate breathing problems if a lung tumor has grown into an airway. A stent, a hard silicone or metal tube, is placed in the airway using a bronchoscope.