Lung cancer

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Treatments for stage 3 non-small cell lung cancer

The following are treatment options for stage 3 non-small cell lung cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemoradiation

Chemotherapy and external radiation therapy may be given together before surgery for stage 3 non–small cell lung cancer. You need to be well enough to have this treatment. Chemoradiation may also be given if you won’t be having surgery and are well enough to have this treatment.

The chemotherapy drug combinations most often used with chemoradiation are cisplatin with etoposide (Vepesid).

Surgery

Surgery may be offered after chemoradiation if the chemoradiation shrinks the tumour enough to make removing it possible.

A lobectomy removes the lobe of the lung where the tumour is. A bilobectomy is a type of lobectomy that removes 2 of the 3 lobes of the right lung.

A sleeve resection removes a tumour from one of the airway tubes of the lung (the bronchi) along with a margin of healthy tissue around the tumour.

A pneumonectomy removes the whole lung.

An extended pulmonary resection removes the muscles, nerves, blood vessels and other tissues near the lung. During the surgery, a wide area of tissue surrounding the lung is taken out to remove as much of the cancer as possible. Surgery for cancer that has grown into the bones of the spine is done using 2 surgeries, one to support the spine with rods followed by another surgery to remove the tumour.

A chest wall resection removes the muscles, bones and other tissues of the chest wall.

For stage 3A non–small cell lung cancer, you may be offered surgery after chemoradiation if the cancer has responded to chemoradiation. You need to be healthy enough to have surgery.

For stage 3B and 3C non–small cell lung cancer, you will not be offered surgery because surgery will not help given where the cancer has spread. You will be offered other treatments.

Chemotherapy

The chemotherapy drug combinations that may be used to treat non-small cell lung cancer are:

  • cisplatin with vinorelbine or etoposide – most common 2 combinations
  • cisplatin (or carboplatin) and gemcitabine
  • cisplatin (or carboplatin) and docetaxel (Taxotere)
  • carboplatin (or cisplatin) and paclitaxel
  • gemcitabine and docetaxel
  • gemcitabine and vinorelbine
  • carboplatin (or cisplatin) and pemetrexed (Alimta) – not used for squamous cell carcinoma of the lung

For stage 3A non–small cell lung cancer, you may have chemotherapy before surgery if you cannot be given radiation therapy. Chemotherapy may also be given after surgery if no chemotherapy was given before surgery or if the cancer responded to chemotherapy given before surgery.

For stage 3B and 3C non–small cell lung cancer, you may have chemotherapy by itself if you are not well enough to have chemoradiation or radiation therapy.

Targeted therapy

Targeted therapy may be used to treat stage 3 non-small cell lung cancer. The type of targeted therapy you have will depend on the type of genetic change (mutation) found during diagnosis using cell and tissue studies and whether there is treatment based on that mutation.

EGFR targeted therapy

Epidermal growth factor receptor (EGFR) is a receptor on the surface of cells that sends signals to cells that allow them to grow and divide. A mutation in the EGFR gene can cause cancer cells to grow and divide more than normal. Cancer cells that have the EGFR mutation are called EGFR positive (EGFR+).

EGFR-positive stage 3B and 3C non-small cell lung cancer may be treated with targeted therapy instead of chemotherapy. Drugs that may be used are:

  • erlotinib (Tarceva)
  • gefitinib (Iressa)
  • osimertinib (Tagrisso)

Erlotinib may also be given as maintenance therapy for stage 3 non-small cell lung cancer after 4 cycles of chemotherapy with cisplatin or carboplatin.

ALK targeted therapy

Anaplastic lymphoma kinase (ALK) is a protein that helps with cell growth and division. It is controlled by the ALK gene. A very small number of non–small cell lung cancers have a change (mutation) in the ALK gene. Cancer cells that have the ALK mutation are called ALK positive (ALK+).

ALK-positive stage 3 non-small cell lung cancer may be treated with crizotinib (Xalkori). If you can’t take crizotinib, other drugs that may be given are:

  • ceritinib (Zykadia)
  • alectinib (Alecensaro)
  • brigatinib (Alunbrig)

ROS1 targeted therapy

The ROS1 gene makes a protein that is responsible for signals in cells and helps with cell growth. A mutation in the ROS1 gene can cause cancer cells to grow and divide more than normal. Cancer cells that have the ROS1 mutation are called ROS1 positive (ROS1+).

ROS1-positive stage 3 non-small cell lung cancer may be treated with crizotinib.

Entrectinib (Rozlytrek) may be offered for ROS1+ stage 3 non–small cell lung cancer, if you have not been given crizotinib as a treatment.

Angiogenesis inhibitors

Bevacizumab (Avastin, MVASI, Zirabev) is a type of targeted therapy called an angiogenesis inhibitor. It targets a protein called vascular endothelial growth factor (VEGF), which helps new blood vessels grow. Bevacizumab is combined with the chemotherapy drugs carboplatin and paclitaxel. This combination may be offered for stage 3 non-small cell lung cancer.

Immunotherapy

Different types of immunotherapy may be used to treat stage 3 non-small cell lung cancer.

Necitumumab (Portrazza) is a type of monoclonal antibody. If you have stage 3 squamous cell non–small cell lung cancer that can’t be treated with surgery and you have not had chemotherapy yet as a treatment, you may be given necitumumab in combination with the chemotherapy drugs gemcitabine (Gemzar) and cisplatin.

Durvalumab (Imfinzi) is a PD-L1 checkpoint inhibitor. If you can’t have surgery, you may be given durvalumab to treat stage 3 non–small cell lung cancer that has stopped growing when it has been treated with chemoradiation. Durvalumab is given until the cancer starts to progress (grow again).

Radiation therapy

External radiation therapy by itself may be given as the main treatment if you have stage 3 non–small cell lung cancer and are not well enough to have surgery, chemotherapy or chemoradiation as treatment.

External radiation therapy may be delivered by 3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT).

Clinical trials

Talk to your doctor about clinical trials open to people with non-small cell lung cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

chest wall

The area of the body between the neck and the abdomen. It includes the rib cage, muscles and tissues that move during breathing.

The chest wall protects the lungs, heart and liver. 

maintenance therapy

Treatment given after the first-line therapy (the first or standard treatment) to keep a disease (such as cancer) under control or to prevent it from coming back (recurring). It may be given for a long period of time.

Maintenance therapy may include drugs, vaccines, antibodies or hormones.

angiogenesis

The growth of new blood vessels.

monoclonal antibody

A substance that can find and bind to a particular target molecule (antigen) on a cancer cell.

Monoclonal antibodies can interfere with a cell’s function or can be used to carry drugs, toxins or radioactive material directly to a tumour.

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