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Treatments for non–small cell lung cancer
If you have non–small cell lung cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for non–small cell lung cancer, your healthcare team will consider:
- the stage of the cancer
- whether the cancer can be removed with surgery
- your overall health, including your lung function
- your personal preferences (what you want)
You may be offered one or more of the following treatments for non–small cell lung cancer.
Surgery may be used for non–small cell lung cancer if it can be completely removed and if you are healthy enough to have surgery. The type of surgery will depend on where the cancer is found in the lung. Lymph nodes are removed with all types of surgery.
Wedge or segmental resection removes the lung tumour along with a margin of healthy tissue around the tumour.
Lobectomy removes a lobe of the lung that has the tumour. A bilobectomy is a type of lobectomy that removes 2 of the 3 lobes of the right lung.
Pneumonectomy removes the whole lung.
Extended pulmonary resection removes the muscles, nerves, blood vessels and other tissues near the lung to take out as much of the cancer as possible.
Chest wall resection removes the muscles, bones and other tissues of the chest wall.
Sleeve resection removes a tumour from the large airway of the lung (bronchus) along with a margin of healthy tissue around the tumour.
External beam radiation therapy may be used for non–small cell lung cancer that can’t be removed with surgery. It may also be used if you are not well enough to have surgery or don’t want to have surgery. It may be given after surgery for stage 3A non–small cell lung cancer.
Radiation therapy is usually combined with chemotherapy to treat non–small cell lung cancer. This is called chemoradiation. The 2 treatments are given during the same time period. It is only offered if you are healthy enough to have both treatments at the same time.
There are several different types of external beam radiation therapy used for non–small cell lung cancer.
- 3-D conformal radiation therapy (3-D CRT)
- intensity-modulated radiation therapy (IMRT)
- stereotactic body radiotherapy (SBRT)
- hypofractionated radiation therapy
Brachytherapy is internal radiation therapy. A radioactive material (radioactive isotope) is placed right into the tumour or very close to it. The radiation kills the cancer cells over time.
Chemotherapy may be used before or after surgery for non–small cell lung cancer. It may also be given as the main treatment if you are not well enough or don’t want to have surgery. Chemotherapy may also be given after standard therapy to slow or stop cancer from coming back (maintenance therapy).
Non–small cell lung cancer is usually treated with a combination of 2 drugs, which is more effective than any one drug alone. The most common chemotherapy drug combinations used for non–small cell lung cancer include cisplatin as one of the drugs.
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.
Targeted therapy is used for non–small cell lung cancer that has spread to the lymph nodes or other parts of the body or has come back after chemotherapy treatments.
The type of targeted therapy offered depends on what type of gene changes (mutations) are found in the cancer cells during molecular tissue tests. Targeted therapy drugs include gefitinib (Iressa), afatinib (Giotrif), erlotinib (Tarceva), crizotinib (Xalkori) and dabrafenib (Tafinlar) with trametinib (Mekinist).
Immunotherapy is used for advanced or metastatic non–small cell lung cancer after it has stopped responding to chemotherapy or targeted therapy. Immunotherapy drugs include pembrolizumab (Keytruda) and nivolumab (Opdivo).
Another immunotherapy drug, necitumumab (Portrazza), may be used in combination with the chemotherapy drugs gemcitabine (Gemzar) and cisplatin. It may be offered as the first treatment for locally advanced or metastatic squamous types of non–small cell lung cancer, in people who are not able to have surgery.
Endobronchial therapies are done inside the bronchi to remove a blockage and help with symptoms, such as problems with breathing, pain or coughing up blood. They may also be used if a person with non–small cell lung cancer cannot have surgery or radiation therapy.
Different types of endobronchial therapies may be used for non–small cell lung cancer.
Bronchial debridement uses cutting tools to remove as much of a tumour as possible to open up the airway and quickly relieve symptoms.
Stent placement puts a small metal or plastic tube into the bronchus to keep the airway open and allow air into the lungs.
Laser surgery uses an intense, narrow beam of light (called a laser beam) to remove a blockage in the airway.
Electrocautery uses an electrical current to remove tissue from the airway.
Photodynamic therapy (PDT) destroys cancer cells with a drug called a photosensitizer. It makes cells very sensitive to light.
Cryosurgery (also called cryotherapy) is a procedure that destroys cancer cells by freezing them. It is not used very often as other endobronchial therapies for non–small cell lung cancer because another bronchoscopy is needed to remove the dead tissue.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 2 years after treatment has finished. These visits allow your healthcare team to follow your progress and recovery from treatment.
Many clinical trials in Canada are open to people with non–small cell lung cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
How can you stop cancer before it starts?
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