Non-Small Cell Lung Cancer Treatment Options

1. Chemotherapy

For patients with non-small cell lung cancer, chemotherapy is used in different ways based on the stage of cancer.  

• Before surgery, in an attempt to shrink a tumor so that a less extensive surgery can be performed.
  
  
• After surgery, to kill any remaining cancer cells that can't be seen with imaging technology.
  
  
• For advanced NSCLC that hasn't spread to distant areas of the body: Sometimes, chemo along with radiation therapy is given as the main treatment for more advanced cancers that have started to grow into nearby areas of the body, making surgery very difficult.
  
  
• For metastatic (stage IV) NSCLC that has spread to other organs in the body: For these patients, chemotherapy might be used to treat the lung cancer tumors that developed in other parts of the body, such as the brain or liver.

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.

2. Radiation Therapy for Non-Small Cell Lung Cancer

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.

• Stereotactic Body Radiotherapy is often used for tumors in the lungs. 
  
  
• Volumetric-Modulated Arc Therapy (VMAT) or RapidArc® Radiotherapy delivers a three-dimensional dose of radiation directly to a tumor. The highly advanced type of IMRT can rotate 360-degrees around the tumor for a faster treatment. 
  
  
• IMRT radiation beams are aimed at the tumor from several directions using various sized beams to conform to the exact shape of the tumor. It also allows for higher doses of radiation to certain parts of the tumor. 

The type of radiation therapy that's used depends on where the lung cancer is located and how extensive it is.

How long do radiation treatments last?

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. 

Which type of radiation therapy is right for you?

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.

3. Surgery and Surgical Resection for Lung Cancer

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:

• A pulmonary test will be given to make sure you would be left with enough functioning lung tissue following the surgery
• Your heart and other vital organs will be tested to make sure that they are healthy enough for you to have surgery
• Your doctor will check to see if cancer has spread to the lymph nodes located between your lungs

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.

4. Immunotherapy to Treat Non-Small Cell Lung Cancer

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.

5. Targeted Therapy for NSCLC

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:

• EGFR

• KRAS

• ALK

• ROS-1

• NTRK

• MET

• RET

• BRAF V600E

• HER2/ERBB2

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.

6. Laser Therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells. It has limited FDA approval for use 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. This type of treatment is currently being studied under investigational uses, so more time for data to mature is needed.

Clinical Trials for Lung Cancer as Part of Some Patients’ Treatment Plans

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.