Treatment of non-small cell lung cancer (NSCLC) depends on where the cancer has spread.
Patients with non-small cell lung cancer, the most common type of lung cancer, are often treated with several types of therapies, such as chemotherapy, radiation therapy, and targeted therapy. Surgery is performed for patients whose tumor can be reached surgically and has not spread beyond a small area of the lung.
Those with metastatic lung cancer (stage IV) or lung cancer that has recurred are likely to have biomarker tests performed to determine if there is a genetic mutation causing the cancer cells to grow. The results of these tests tell your oncologist if there is a targeted therapy that would work well.
Read more about the common treatment options for NSCLC and how they are used for each lung cancer stage.
For patients with non-small cell lung cancer, chemotherapy is used in different ways based on the stage of cancer.
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the lung cancer being treated.
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing.
For lung cancer, external beam radiation therapy is most commonly used. There are a few different types of external radiation that can help lung cancer patients.
The type of radiation therapy that's used depends on where the lung cancer is located and how extensive it is.
Hypofractionated radiation therapy had made it possible to reduce the total time required for radiation therapy treatments. Traditionally it would take 6-8 weeks to complete the sessions. With this different approach to delivering radiation, treatments can be complete in 4-5 weeks. The same amount of radiation is given in a shorter time frame, with higher doses of radiation in each session. The shorter course for radiation treatments is possible with the use of advanced technology that precisely aims radiation, allowing the cancerous cells to be treated with a higher dose while sparing nearby organs and tissues. The final number of treatments depends on the specific cancer diagnosis.
Your radiation oncologist will work with you to determine which type of radiation is best for you if it's recommended in your treatment plan for non-small cell lung cancer. The radiation oncologists at WVCI offer radiation therapy technology in Eugene, Oregon.
Early-stage NSCLC patients are more likely to have surgery to remove the cancer. Surgery as a treatment option becomes more difficult as the cancer spreads throughout the lung(s) in later-stage non-small cell lung cancer. Lung cancer surgery can involve removing a portion of the lung or the entire lung through procedures such as lobectomy, segmentectomy, wedge resection, and pneumonectomy. The lung cancer doctor may also remove lymph nodes to see if they contain cancer.
If your lung cancer doctor recommends surgery as part of the treatment plan, then the following will take place:
Even if the lung cancer surgeon removes all cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery to lower the risk that your lung cancer will come back is called adjuvant therapy.
Immunotherapy also called biologic therapy, is essentially a cancer treatment that uses your own immune system to help fight cancer. Substances produced by your body or made in a laboratory are used to jumpstart your body’s natural defense against disease.
Lung cancer immunotherapy belongs to a class called checkpoint inhibitors. These “checkpoints” — proteins on immune cells that need to be turned on (or off) to start an immune response — are what the immune system uses to keep itself from attacking your normal cells. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immunotherapy medications allow the immune system to recognize and destroy cancer cells.
Over the last few years, immunotherapies have shown to be effective at treating lung cancer alone and in combination with chemotherapy or radiation therapy. Recent studies have shown that certain patients can obtain a long-term response with immunotherapy.
Cancer treatment vaccines (also called therapeutic vaccines) and adoptive T-cell therapy are other types of immunotherapy that are being studied in clinical trials.
Targeted therapy targets proteins that allow the cancer cells to grow, divide and spread. This therapy precisely targets the cancer cells and leaves healthy cells alone, which reduces the side effects of other cancer treatments. Monoclonal antibodies, tyrosine kinase inhibitors, and mammalian target of rapamycin (mTOR) inhibitors are the three types of targeted therapy being used to treat certain types of lung cancer.
Late-stage non-small lung cancer patients may go through biomarker testing, also called genomic testing, to look for genetic mutations in the cancer cells. If one of a few specific genetic mutations is found in the cancer cells, the recommended treatment will be based on that.
There are currently FDA-approved targeted therapies for non-small cell lung cancer tumors showing the following genetic mutations:
A different treatment plan will be recommended for patients who do not test positive for a biomarker with an approved targeted therapy. They may also be eligible for a clinical trial that is identifying treatments based on other biomarkers found outside of those with an established targeted therapy.
Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells. It is often used alongside other forms of non-small cell lung cancer treatment. It is sometimes used when a tumor is blocking off the airway and making it difficult for you to breathe properly.
Your lung cancer doctor may suggest participating in a clinical trial for lung cancer as part of treatment if you are eligible. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments that aren’t yet widely available for lung cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients who have not started treatment may want to consider taking part in a clinical trial.
If you have been newly diagnosed with lung cancer, the first step is to schedule a consultation with a lung cancer specialist at WVCI. We offer personalized treatment plans, including the latest cancer treatments available, as well as second opinions on treatment in Albany, Corvallis, Eugene, Florence, Lincoln City, and Newport, Oregon.