Chemotherapy for non–small cell lung cancer
Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. Most people with non–small cell lung cancer have chemotherapy. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.
Chemotherapy is often combined with radiation therapy to treat non–small cell lung cancer. This is called chemoradiation. The 2 treatments are given during the same time period.
Chemotherapy is given for different reasons. You may have chemotherapy:
- to shrink a tumour before other treatments such as surgery or radiation therapy (called neoadjuvant chemotherapy)
- to destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
- as the main treatment (with or without radiation therapy) for people who aren’t well enough to have surgery or for cancer that can’t be removed with surgery
- to relieve pain or control the symptoms of advanced non–small cell lung cancer (called palliative chemotherapy)
- as maintenance therapy in people who have advanced non–small cell lung cancer that has responded to chemotherapy
Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the lung.
Chemotherapy drugs commonly used for non–small cell lung cancer
Non–small cell lung cancer is usually treated with a combination of 2 drugs, which is more effective than any one drug alone. Adding a third drug doesn’t make the chemotherapy more effective, but it may cause more side effects. Drug combinations are given through a vein (intravenously) for 3 to 6 cycles. In some cases, chemotherapy may be given until the cancer starts to grow again.
The most common chemotherapy drug combinations used for non–small cell lung cancer include cisplatin as one of the drugs. If a person cannot be given cisplatin because of poor health, a related drug called carboplatin (Paraplatin, Paraplatin AQ) may be given.
The most common chemotherapy drug combinations used to treat non–small cell lung cancer are:
- cisplatin and etoposide (Vepesid, VP-16) – used most often with chemoradiation
- cisplatin and vinorelbine (Navelbine)
- cisplatin and gemcitabine (Gemzar)
- cisplatin and docetaxel (Taxotere)
- carboplatin and paclitaxel (Taxol)
- cisplatin and pemetrexed (Alimta) – not used for squamous cell types of non–small cell lung cancer
Single chemotherapy drugs may be used to treat a person with advanced or metastatic non–small cell lung cancer if they can’t have combination chemotherapy because of poor health or other medical conditions. Single drugs may also be used if combination chemotherapy has stopped working.
The most common single drugs used to treat non–small cell lung cancer are:
- albumin-bound paclitaxel (Abraxane)
- irinotecan (Camptosar)
- pemetrexed – not used for squamous cell types of non–small cell lung cancer
Maintenance therapy is treatment given after standard therapy to slow or stop cancer from coming back. It may be offered for advanced or metastatic non–small cell lung cancer that has responded to chemotherapy.
The drug pemetrexed may be given as maintenance therapy for adenocarcinoma (non-squamous) types of non–small cell lung cancer.
Side effects can happen with any type of treatment for non–small cell lung cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.
Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for non–small cell lung cancer are:
- low blood cell counts
- nausea and vomiting
- hair loss
- peripheral nerve damage
- loss of appetite
- sore mouth and throat
- skin problems
Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
Information about specific cancer drugs
Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.
Questions to ask about chemotherapy
Because of smoke inhalation and exposure to toxic chemicals, I live with the fear of cancer virtually every day.
What’s the lifetime risk of getting cancer?
The latest Canadian Cancer Statistics report shows about half of Canadians are expected to be diagnosed with cancer in their lifetime.