Chemotherapy for Lung Cancer

Chemotherapy refers to the use of cytotoxic (cell-killing) medications to kill cancer cells. It's often used to treat lung cancer either alone or in conjunction with other modes of treatment. Chemotherapy for lung cancer may be given before or after surgery, along with immunotherapy medications or radiation, or as a means of managing metastatic lung cancer and extending life.

How Chemotherapy Works

Chemotherapy medications work by killing rapidly dividing cells. Since cancer cells divide quicker than most cells, they are particularly susceptible to these drugs.

Different chemotherapy medications work at different stages of cell division. For this reason, two or more medications are often given at the same time to kill as many cancer cells as possible. This is known as combination chemotherapy.

Combining chemo medications offers several benefits:

  • Decreases the chance that tumors will become resistant to treatment
  • Attacks the cancer with everything early on rather than waiting to see which one drug will be most effective
  • Targets different aspects of the cancer cells all at once
  • Addresses the fact that cancer cells continually change and different cells may respond to different drugs
  • Combined drugs are more powerful than one drug used on its own

When Chemotherapy Is Used For Lung Cancer

Unlike surgery and radiation therapy, which are considered local treatments (targeting the tumor directly at its location), chemotherapy is a systemic treatment, meaning that it works to kill cancer cells throughout the body.

Chemotherapy for lung cancer is often recommended to:

  • Kill cells remaining after surgery: Known as adjuvant chemotherapy, this treatment is used after tumors have been removed to kill any cancer cells that may have spread but are undetectable by scans. It is often recommended for people with stage 2 and stage 3A non-small cell lung cancer to reduce the risk of recurrence.
  • Shrink a tumor before surgery: In some cases, chemotherapy is used before surgery to shrink a tumor and improve the chances that surgery will be effective. This method is often referred to as neoadjuvant chemotherapy.
  • Prolong life: In cases of advanced lung cancer, chemotherapy can extend life by reducing the size of a tumor or preventing additional growth. This is referred to as maintenance chemotherapy.
  • Lessen cancer symptoms: When a tumor is causing symptoms such as pain or shortness of breath, chemotherapy may be able to reduce the size of the tumor to decrease symptoms. 
  • Help immunotherapy drugs work: Immunotherapy drugs (checkpoint inhibitors) stimulate the immune system to fight cancer, but sometimes cancer cells can hide. Chemotherapy drugs break the cells down so the immune system can identify them and target malignancies.
  • Put cancer into remission: Lung cancer is rarely ever able to be fully cured. However, when chemo is combined with immunotherapy drugs, some people may experience full or partial remission and long-lasting control of their cancer.

When chemotherapy is given only to ease symptoms or improve quality of life—and not with the intent of curing lung cancer or improving survival—it's referred to as palliative chemotherapy. If your doctor suggests chemo for this reason, be sure to discuss it carefully. If you prefer continuing to fight the cancer, be clear about that with your doctor.

First-Line Therapy

First-line therapy refers to the first treatment given, including any combination of medications. These drugs are considered the "gold standard" of treatment and are most likely to be effective. Increasingly, immunotherapy drugs such as Keytruda (pembrolizumab) are being used, either alone or in combination with chemotherapy, as first-line therapy for non-small cell lung cancer.

Because some genetic mutations that underly lung cancer can be specifically targeted with certain drugs appropriately called targeted therapies, it is now common practice for oncologists to order genetic testing before deciding which options to use as first-line treatments.

Second-Line Therapy

For patients that start with targeted therapy, chemotherapy may be brought in as a second-line therapy either because the cancer is continuing to grow or because side effects from other treatments cannot be tolerated.

In other cases, chemotherapy may be combined with a targeted therapy drug as a second-line treatment. For instance, chemo is sometimes used with Cyramza (ramucirumab), which stops the formation of new blood vessels so a tumor can't survive.

Second-line treatment is less likely to be effective than first-line treatment, but it can offer a longer and better quality of life. Many people living with lung cancer now receive further therapies (third-line, fourth-line treatment, and so on).

Chemotherapy Drugs and Delivery

Many different medications are used to treat lung cancer. Most commonly, treatment of non-small cell lung cancer begins with either cisplatin or carboplatin (these are known as "platinum" drugs) combined with another medication. Common medications used in lung cancer include:

  • Platinol (cisplatin)
  • Paraplatin (carboplatin)
  • Taxotere (docetaxel)
  • VePesid or Etopophos (etoposide)
  • Gemzar (gemcitabine)
  • Taxol (paclitaxel)
  • Alimta (pemetrexed)j
  • Navelbine (vinorelbine)

With small cell lung cancer, first-line treatment usually includes a combination of a platinum drug and VePesid (etoposide), often in combination with the immunotherapy drug Tecentriq (atezolizumab).

Second-line treatment may include either the immunotherapy drug Opdivo (nivolumab) or a single chemotherapy drug such as Taxol (paclitaxel) or Hycamtin (topetecan).

How They Are Given

Some chemotherapy medications are given as an oral pill, but most are given intravenously.

If you will be having IV chemotherapy, you may be asked to make a choice between having an IV placed at each visit or having a chemotherapy port placed. With a port, an intravenous line is threaded into the large blood vessels near the top of the chest and a small metal or plastic device is placed under your skin.

There are advantages and disadvantages to each method, yet a port (or sometimes a PICC line) can reduce the number of needle sticks necessary during treatment.

The initial treatment for lung cancer usually involves a combination of two or more drugs. These are often given in cycles of three to four weeks at least four to six times.

Using a combination of drugs that work at different phases of cell division increases the chance of treating as many cancer cells as possible. Since different cells are all in different places in the process, repeated sessions increase the chance of treating as many cancer cells as possible.

Side Effects of Chemotherapy

Many side effects of chemotherapy are related to the "normal" effect of chemotherapy on rapidly dividing cells. Cells that divide most rapidly include those in bone marrow, hair follicles, and the digestive tract, so chemotherapy has a significant impact on these areas.

Everyone responds to chemotherapy differently. However, some side effects are common:

Another problem is neutropenia (low white blood cell count), which the majority of cancer patients develop. Having a low white blood cell count can predispose you to infections and sometimes cause very serious health concerns that, as a chemo patient, you should watch for and discuss with your doctor.

What you will experience depends on the medications you're given and other factors such as your age, sex, and general medical condition. Thankfully, tremendous strides to help people manage these issues have been made over the past few decades.

Coping and Supporting Your Body

Good nutrition is an essential part of staying strong during chemo treatments. Some people include complementary treatments such as nutritional supplements into their diets.

Discuss any supplements you want to take while undergoing chemo with your oncologist before doing so. Certain supplements can decrease the effectiveness of chemotherapy drugs for lung cancer, while others may make the medication toxic.

As for side effects, you may have few or you may have severe reactions to your medication(s). These can improve or worsen over time.

Sometimes a medication may need to be changed, but often there are medications and treatments that can control your symptoms and make you more comfortable.

Some ways to manage side effects include:

  • Antinausea medications: Often these are given preventatively with some chemo drugs so that you may never feel sick to your stomach. Other times they are offered on an as-needed basis.
  • Good oral hygiene: This is imperative to managing mouth sores and preventing oral infections.
  • Iron supplements: These may be prescribed to offset anemia and fatigue, but the first course of treatment is to get rest and alter your lifestyle. Fighting cancer will require you to slow down.
  • Brain exercises: To combat the hazy-mind feeling and forgetfulness that can occur with chemobrain, some people make an effort to keep their mind engaged by doing crossword puzzles or other stimulating activities.

The management of chemo side effects has improved significantly in recent years. If you're struggling with the effects of these drugs, it may be helpful to join a cancer support group where you'll have the opportunity to talk to others who are experiencing similar challenges in their lives.

Why Can't Chemo Cure Lung Cancer?

Doctors rarely use the word "cured" in relation to lung cancer except in instances where some very early-stage non-small cell lung cancer tumors are eradicated with surgery. Even if you go into remission and have no evidence of cancer for years, the risk of dying from cancer persists for 15 years.

The reason chemotherapy does not cure lung cancer for good is that tumors become resistant to the drugs over time. Cancer cells are, in a way, "smart." They constantly change and develop methods for escaping the treatments doctors send their way.

Resistance is one reason why—when someone has a tumor that has begun to grow again on chemotherapy—different drugs are often used the next time around.

What Is a Durable Response?

With a combination of chemotherapy and immunotherapy, some people have experienced partial or complete remission of their cancer. Though the word "cure" still isn't used in this situation, some cancers may be controlled for a long period of time. Oncologists call this a durable response.

A Word From Verywell

The effectiveness of lung cancer treatments and their possible side effects is a lot to process. Particularly when chemotherapy for lung cancer is recommended, beginning can be a significant physical and emotional undertaking. It may help to remember that chemo of the past is not the same as it is today. Many of the significant side effects people once endured are better now less common due to improved treatments and management.

Chemotherapy is still challenging, however, so you will need to build a strong support network to help you through the tough times. Surround yourself with those who can help you through all of the facets of treatment.

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