Non-Small-Cell Lung Cancer: Advances in Treatment

By
Lisa Fields
WebMD Feature

Reviewed by
Melinda Ratini, DO, MS

Chemotherapy once was the only medicine doctors could prescribe to someone with non-small-cell lung cancer (NSCLC). Times have changed. There are not only advances in the chemotherapy itself, but there are new kinds of medications to treat this disease.

One group of the drugs changes the way certain cancer cells grow or change in your body. Doctors call this targeted therapy. The other boosts your immune system to better fight cancer. It’s called immunotherapy.

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General Information About Non-Small Cell Lung Cancer (NSCLC)

NSCLC is any type of epithelial lung cancer other than small cell lung cancer (SCLC). The most common types of NSCLC are squamous cell carcinoma, large cell carcinoma, and adenocarcinoma, but there are several other types that occur less frequently, and all types can occur in unusual histologic variants. Although NSCLCs are associated with cigarette smoke, adenocarcinomas may be found in patients who have never smoked. As a class, NSCLCs are relatively insensitive to chemotherapy and radiation therapy…

Read the General Information About Non-Small Cell Lung Cancer (NSCLC) article > >

Chemotherapy

Just the word may make you think of unpleasant side effects like nausea and vomiting. Although that can still happen, there are better medicines to tame it, says Kenneth Ng, MD, chief of medical oncology at Memorial Sloan Kettering Rockville Centre in New York.

Sometimes chemo does cause fatigue, depression, nerve problems, memory problems, or hair loss. They happen because of the way the drugs work.

“Chemotherapy actually kills the cancer cells, but it doesn’t only kill cancer cells, it kills normal cells as well,” says Shakun Malik, MD, at the National Cancer Institute’s Cancer Therapy Evaluation Program.

But there is chemo for NSCLC that doesn’t cause hair loss, and memory problems can be milder for some people. That’s true for newer chemo drugs and updated versions of older ones. “It’s better compared to before,” Ng says.

You’re likely to get more than one type of chemo drug to start with. That’s routine now. “Combining two to three different chemotherapy drugs works better than giving one chemotherapy drug,” Ng says.

In 2016, the FDA gave hope to patients with advanced NSCLC whose tumors carry a genetic mutation called ROS-1 by approving the drug (Xalkori). The oral medication acts as a protein inhibitor, blocking ROS-1’s activity, which potentially could prevent NSCLC from growing and spreading.

Targeted Therapy

These drugs target cancer cells based on certain types of genetic information and kill them without harming healthy ones around them.

Doctors will take a sample of your tumor. Then they’ll see if the cancer cells will respond to one of these drugs. About 15% to 20% of people with NSCLC can get targeted therapy. If you’ve never smoked, the odds are better that it’ll work for you.

Non-Small-Cell Lung Cancer: Advances in Treatment

Targeted Therapy continued…

People tend to do well with these medicines, which are tablets you take by mouth. “You don’t have to come to the doctor’s office every 2 to 3 weeks and get hooked into an IV,” Malik says.

Side effects are milder than those that come with chemo. Skin rashes, nail changes, diarrhea, and fatigue are common.

Doctors mainly use targeted therapy in people who have advanced (stage IV) NSCLC. It can help them live longer. Researchers are working to see if these treatments can also help people with early-stage NSCLC.

Immunotherapy

If your cancer is in a late stage, this new type of medicine can boost your immune system and help it fight cancer cells. The FDA has approved two immunotherapy drugs for lung cancer, including NSCLC. They are nivolumab (Opdivo) and pembrolizumab (Keytruda). Others are in the works. 

You get immunotherapy as a shot every 2 weeks at a doctor’s office.

Side effects are minimal, Ng says. Fatigue and achy joints are common. In rare cases, immunotherapy can cause inflammation in the lungs, liver, thyroid, pituitary gland, brain, or colon.

“You’re unleashing the immune system to go and attack the cancer,” says George R. Simon, MD, of the University of Texas M.D. Anderson Cancer Center in Houston.

Sometimes it can turn on the body and attack something it isn’t supposed to.

Scientists are studying other ways to use these types of treatments. People with early-stage cancer might get them before they have surgery. Others might take them together with chemotherapy.

Imagine, Ng says — you’d get chemo to fight the cancer at the same time you take drugs to strengthen your immune system.