After you’re diagnosed with lung cancer, your doctor or oncologist will discuss suitable treatments with you. Your options will depend on the stage of your cancer and how much the cancer has spread. The two main types of lung cancer — small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) — may be treated differently.
Surgery
Surgery to remove your lung tumor may be an option if your cancer is found in its early stages. Several types of surgeries are performed, including:
Pneumonectomy Your surgeon removes your entire lung with this procedure. You might need a pneumonectomy if your tumor is close to the center of your chest.Lobectomy The lobe that contains the tumor is removed if you have a lobectomy. Your right lung is made up of three lobes, and your left lung is made up of two lobes.Segmental Resection With this surgery, a large portion of your lung is removed — but not the entire lobe.Wedge Resection This procedure involves removing only a small part of the lobe that contains the tumor.
During surgery, your doctor may take out some lymph nodes from your chest to see if the cancer has metastasized — or spread — to them. Minimally invasive surgical techniques, which require a smaller incision and from which the recovery is usually easier, may also be available. Your doctor will choose the type of procedure according to the size and location of your tumor as well as your lung function. Risks of surgery may include bleeding, infection, blood clots, and, rarely, death. You may have certain side effects such as shortness of breath after surgery. RELATED: Have You Been Screened for Lung Cancer? Most of the time, RFA is performed as an outpatient procedure using local anesthesia. People with small tumors near the outer part of the lung are usually good candidates for RFA.
Chemotherapy
Chemo is a treatment that involves delivering anti-cancer medicines by injecting them into a vein or taking them by mouth. This treatment is used before or after surgery to kill remaining cancer cells, but it can also be given before surgery to shrink tumors. Chemo can be used along with radiation or targeted therapies. Chemotherapy is often used in patients with advanced lung cancer that can’t be surgically removed or treated with radiation in order to shrink tumors. Occasionally it’s used to relieve symptoms caused by growing tumors. The following chemo drugs are commonly given to people with lung cancer:
CarboplatinCisplatinPaclitaxel (Taxol)Albumin-bound paclitaxel or nab-paclitaxel (Abraxane)Docetaxel (Taxotere)Gemcitabine (Gemzar)Vinorelbine (Navelbine)Irinotecan (Camptosar)Etoposide (VP-16)VinblastinePemetrexed (Alimta)
These medicines are usually combined, but depending on the situation, you may take just one at a time. Most first-line chemo regimens are platinum-based, meaning they use platinum compounds such as cisplatin or carboplatin, plus another drug. Side effects of chemo include hair loss, nausea, vomiting, fatigue, bruising, loss of appetite, mouth sores, diarrhea, constipation, and an increased risk of infection. There are many medications that you are given with chemotherapy to help minimize these side effects, and there are many additional medications that you can take as needed to help with side effects such as nausea. RELATED: What Is a Liquid Biopsy for Lung Cancer — and Do You Need One?
Radiation Therapy
Radiation uses high-energy beams, such as X-rays or protons, to kill cancer cells. The beams may come from a machine outside the body that focuses on the tumor. This is called external beam radiation and includes three-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and stereotactic radiosurgery (SRS). Sometimes needles, seeds, or catheters are placed inside the body to deliver radiation, which is known as brachytherapy. Your doctor may recommend radiation instead of surgery if your lung tumor can’t be removed because of its size or location in the lung. Some people with advanced lung cancer receive radiation to relieve pain and improve their symptoms. Side effects of radiation may include fatigue, nausea, vomiting, weight loss, loss of appetite, hair loss, or skin changes. Radiation may be given before or after surgery and is sometimes combined with chemotherapy. Additionally, this treatment is also used on areas of the body where cancer has spread.
Targeted Therapy
Newer treatments that target certain abnormalities in cancer cells are known as targeted therapies. These drugs are different from chemotherapy in the way they work. Unlike chemo, targeted therapy specifically attacks cancer cells that have mutations in the cancer DNA that are not seen elsewhere in the body. Targeted therapy is used most often in people with advanced lung cancer. Sometimes, these medicines work for a period of time but then stop being effective. Typically, targeted medicines don’t cause as many side effects as chemo, but you could experience rash, diarrhea, fatigue, nausea, high blood pressure, liver function issues, and heart, vision, or lung problems. Most targeted drugs work only if you have certain mutations, or changes, in your genes. Your doctor can test you for specific gene mutations. Mutations that may be treated with targeted therapies include: EGFR Mutations Changes in the epidermal growth factor receptor (EGFR) gene can be treated with drugs, such as:
Erlotinib (Tarceva)Afatinib (Gilotrif)Gefitinib (Iressa)Osimertinib (Tagrisso)
While these targeted therapies are typically only used in patients with advanced disease, the U.S. Food and Drug Administration (FDA) recently approved Tagrisso for certain patients found to have an EGFR mutation after their tumor is surgically removed. ALK Mutations About 5 percent of NSCLCs have a mutation in the ALK gene. Drugs that target ALK changes include:
Crizotinib (Xalkori)Ceritinib (Zykadia)Alectinib (Alecensa)Brigatinib (Alunbrig)
ROS1 Mutations The drug Xalkori, which is used to treat ALK mutations, may also help some people with ROS1 mutations. BRAF Mutations Meds that target changes in the BRAF gene are:
Dabrafenib (Tafinlar)Trametinib (Mekinist)
As doctors learn more about genes and the therapies that target them, more treatments are likely to become available. For instance, the FDA has recently approved drugs for RET rearrangements, MET mutations, and KRAS G12C mutations.
Immunotherapy
Immunotherapy uses medicines to stimulate the body’s immune system to target and kill cancer cells more effectively. These drugs are given as an intravenous (IV) infusion. Available immunotherapy medicines include: PD-1 Inhibitors These drugs block the PD-1 protein to help boost the body’s immune system response to fighting cancer cells. Examples are:
Nivolumab (Opdivo)Pembrolizumab (Keytruda)Cemiplimab (Libtayo)
PD-L1 Inhibitors Meds that block the PD-L1 protein can help the body respond better to cancer cells. Atezolizumab (Tecentriq) and durvalumab (Imfinzi) are PD-L1 inhibitors. Immunotherapies can be used alone or with other treatments. The American Society of Clinical Oncology (ASCO) guidelines suggest that immunotherapy should be used as a first line therapy in people with advanced lung cancer who have high PD-L1 expression in their tumor without gene mutations. Recent clinical trials demonstrate that these drugs may also be beneficial when used before or after surgery, though this is not a standard, FDA-approved method of treating patients yet. Side effects of immunotherapy medicines may include cough, itching, fatigue, rash, constipation, loss of appetite, diarrhea, and joint pain. RELATED: Why Are ‘Never-Smokers’ Getting Lung Cancer?
Lung Cancer Survival
Survival rates are often used to talk about the outlook for a person with lung cancer. Statistics on survival rates depend on the stage of your cancer at the time you were diagnosed. The five-year survival rate refers to the percentage of people who live at least five years after their cancer is diagnosed. Some people may live much longer than five years. The five-year survival rate for all lung cancers is about 18 percent, though this number lumps people with early cancers — many of whom are cured — together with patients with incurable metastatic advanced cancer. Moreover many of the statistics for survival are based on data from an era with fewer treatment options than we have now. More than half of people with lung cancer die within a year of being diagnosed. The five-year survival rate for lung cancer caught at an early stage is about 54 percent. It’s about 4 percent for cancer that has spread to other parts of the body. Although lung cancer is a serious disease, more people are getting diagnosed earlier, and treatments have improved in recent years. Because of these advances, experts believe people with lung cancer may have a better outlook than statistics currently suggest.
