Treatment for Lung Cancer

Research has shown that the combination of chemotherapy and radiation therapy (often referred to as chemoradiation therapy), with or without surgery, provides the best outcomes for most individuals with stage III non-small cell lung cancer. The combination of chemotherapy and radiation therapy is also the most commonly used treatment for limited stage small cell lung cancer. Chemotherapy with supportive care is given for stage IV non-small cell cancer or extensive stage small cell lung cancer. 

Several chemotherapy drugs have been shown to kill lung cancer cells (Table 1). For initial treatment (first-line treatment), a two-drug combination is typically used, and one of the drugs is usually a platinum drug (cisplatin or carboplatin). Chemotherapy is given in cycles, or a series of treatments for several days. Each cycle (usually 21 days) is followed by a rest period to allow the individual’s body to recover from the effects of the drugs. The number of cycles given depends on the type and stage of the cancer — but is usually four to six cycles for lung cancer. If the cancer does not respond during treatment or progresses, different chemotherapy drugs may be used as second-line treatment. There are many clinical trials adding a new drug to these regimens. For patients with epidermal growth-factor receptor gene (EGFR) mutations, erlotinib or gefitinib (pills) may be superior (see Targeted Therapy below).

The latest advance in the treatment of nonsmall-cell lung cancer is targeted therapy. Targeted therapy involves the use of drugs or biologic substances that attack lung cancer cells specifically without harming normal cells. Three targeted therapy drugs have been approved for the treatment of advanced non-small cell lung cancer or lung cancer that has progressed during treatment (Table 2). These drugs may be given alone or in combination with chemotherapy. Targeted therapy is most often used for individuals with advanced non-small cell lung cancer and/or individuals who have nonsmall-cell lung cancer that has not responded to one or two combinations of traditional chemotherapy drugs. Targeted therapy is not effective for small cell lung cancer. Recent data show that an oral pill (erlotinib or gefitinib) is superior to multi-agent intravenous chemotherapy as initial treatment for stage IV lung cancer patients whose tumors have EGFR mutations.

Websites with information on targeted therapy drugs are listed here:

• www.immunotherapyforcancer.info
• http://chemoregimen.com/Lung-Cancer
• www.cancer.gov/drugdictionary
• www.fda.gov/Drugs/default.htm

Surgery offers the best chance for cure of early stage non-small cell lung cancer (stage I or II). Surgery may be done to remove a small part of the lung where the tumor is located. This is known as wedge resection. Depending on the size and location of the tumor — and the overall health of the lungs — it may be preferable to remove a lobe of the lung containing the tumor (known as lobectomy) or, less often, the entire lung (pneumonectomy). Nearby lymph nodes must be removed during any of these operations. A pathologist will examine the lymph nodes to determine if they contain cancer cells. It is important to know whether there are cancer cells in the lymph nodes, as more aggressive treatment is needed to kill cancer that has spread beyond the lung.  Surgery is sometimes done as part of treatment of stage III non-small cell lung cancer but it is rarely done for stage IV disease. Surgery is sometimes done for limited stage small cell lung cancer.

Surgery to remove all or part of a lung is done with the patient under general anesthesia. Individuals who have no other lung disease (such as chronic bronchitis or emphysema) can usually gradually resume normal activities after the operation. However, individuals who have another lung disease may need to limit activity or wear oxygen tubes because of shortness of breath after the surgery.

Video-assisted thoracic surgery (VATS) is a new approach that is less invasive than traditional lung cancer surgery. It has been evaluated in patients who have stage I or II disease. The procedure enables the surgeon to make much smaller incisions than those used for open surgery, which means the length of time needed for recovery is shorter. VATS may be beneficial for older or frail individuals or those who are unable to tolerate major surgery.

Table 1. Chemotherapy Drugs for Lung Cancer

Table 2. Targeted Therapy for Non-Small Cell Lung Cancer

• Erlotinib (Tarceva) for Advanced Lung Cancer
• Tarceva (Erlotinib) Treatment for Lung and Pancreas Cancer
• What is Stereotactic Radiation Treatments for Lung Tumors?