Chemotherapy, Targeted Therapy, Immunotherapy for Lung Cancer Treatment

Our medical oncologists consider the stage, type and subtype of lung cancer, the patient’s overall health, personal preferences and tolerance of different side effects.

They also consider:

• Presence of genetic mutations driving the cancer, as some drugs target gene mutations, increasing their effectiveness and likelihood of response.
• Drug dose
• Drug combinations, includingow many drugs to use and how often
• Whether or not to combine drugs with radiation therapy and if drugs should be given before, after or at the same time as radiation therapy.

Types of Lung Cancer and Chemotherapy Treatment Options

Chemotherapy is the treatment backbone for a significant number of lung cancer patients. Once the stage of the cancer is known, a medical oncologist determines the most appropriate chemotherapy drugs.

Chemotherapy for Small Cell Lung Cancer

The standard treatment approach for small cell lung cancer that has not spread (limited stage) is chemotherapy and radiation given at the same time. This is followed by immunotherapy.

Extensive stage small cell lung cancer is generally treated with chemotherapy and immunotherapy first and may be followed by radiation therapy to the chest, the brain and other locations where the disease has spread. This depends on the cancer’s response to chemotherapy and any symptoms the patient may be experiencing.

For some patients, an immunotherapy called bispecific antibody T-cell engager therapy (BiTEtherapy) may be an option. The FDA-approved it for patients who have stage IV small cell lung cancer when their cancer progresses after initial treatment or when initial treatment stops working.

Chemotherapy for Non-Small Cell Lung Cancer

Non-small cell lung cancer has more subtypes and more diverse treatment options.

• Stage I: If lung cancer is confined to the lung and surgically removed, chemotherapy is sometimes given to prevent recurrence.
• Stages II and III: Chemotherapy is used for lung cancer that is confined to the chest. It can be given in combination with radiation therapy and surgery when complete removal of the cancer treatment appears possible.
• Stage IV, metastatic: Medications are the mainstay of treatment. They clear the bloodstream of cancer and prevent new sites of cancer from developing, while also treating the known sites of cancer. Medication choice is driven by biomarkers. Genomic testing is done to evaluate for the presence of “driver alterations.” Driver alterations are changes in the DNA sequence of genes that cause normal cells to become cancer cells and grow and spread in the body. Driver alterations can be targeted with medications (mostly oral pills) that turn off the driver alteration and cause cancer cells to die. Examples of actionable driver alterations that can be targeted with medications include EGFR, ALK, ROS1, RET, BRAF V600E, MET exon 14, HER2 exon 20 and NTRK.

If there are no driver alterations to target in the cancer, immunotherapy forms the backbone of treatment. Cancers that have high tumor PD-L1 levels generally respond well to a single immunotherapy drug. Cancers have low tumor PD-L1 levels typically are treated with combination therapies of chemotherapy plus immunotherapy or multiple immunotherapies at the same time. PD-L1 is a protein that acts as a kind of “brake” to keep the body's immune responses under control. 

Optune^® Lua for Non-Small Cell Lung Cancer

Tumor Treating Fields (TTFields) is FDA-approved for treating stage IV, metastatic non-small cell lung cancers (NSCLC). This wearable technology sends electrical fields into the tumors. The electricity treats metastatic NSCLC by keeping cancer cells from growing and multiplying, slowing growth or by destroying these cells.