Talk to Your Doctor About Treatment Options
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for about 85% of all lung cancer cases. Treatment plans for NSCLC depend on several factors such as the stage of the disease, tumor size, whether the cancer has spread and a patient’s overall health. This article explores five different NSCLC treatment options.
1. Surgery
Surgery is often considered when NSCLC is diagnosed at an early stage and the tumor has not spread far beyond the lungs. The main goal is to physically remove the cancerous tissue. Depending on the location and size of the tumor, a surgeon may recommend:
- Lobectomy. The removal of an entire lobe of the lung, which is the most common procedure for localized NSCLC.
- Pneumonectomy. The removal of the entire lung if the tumor involves a large central area.
- Segmentectomy or wedge resection. The removal of a small portion of the lung, often used when patients cannot tolerate more extensive surgery due to other health conditions.
2. Chemotherapy
Chemotherapy uses powerful drugs to kill rapidly dividing cancer cells. For NSCLC, it is often given either before surgery (neoadjuvant therapy) to shrink tumors, after surgery (adjuvant therapy) to reduce recurrence, or as the main treatment when surgery is not an option.
Common chemotherapy drugs for NSCLC include cisplatin, carboplatin, paclitaxel, docetaxel, gemcitabine, vinorelbine and pemetrexed. These medications are usually delivered intravenously in cycles, giving the body time to recover between treatments.
Side effects can include fatigue, nausea, vomiting, hair loss, anemia and an increased risk of infection. This can occur because chemotherapy also damages healthy cells that divide quickly. Anti-nausea medications, growth factor support and dose adjustments may help patients tolerate treatment better.
3. Radiation Therapy
Radiation therapy uses high-energy beams to destroy cancer cells. It may be used alone or in combination with surgery and chemotherapy.
- External beam radiation therapy (EBRT) is the most common approach, where a machine directs radiation precisely at the tumor from outside the body.
- Stereotactic body radiotherapy (SBRT) delivers higher doses over fewer sessions with extreme precision. This is often used in early-stage NSCLC for patients who cannot undergo surgery.
Radiation can shrink tumors, control symptoms like pain or bleeding and kill microscopic cancer cells left after surgery. Side effects include fatigue, skin irritation at the treatment site, difficulty swallowing and inflammation of the lungs known as radiation pneumonitis. Most side effects improve after therapy ends, although some lung scarring can be long-term.
4. Targeted Therapy
Targeted therapy works by blocking specific genes, proteins or pathways that cancer cells rely on to grow and spread. Unlike chemotherapy, which affects all rapidly dividing cells, targeted therapies are more selective and can have fewer side effects.
Some of the most important targets in NSCLC include:
- EGFR mutations. Drugs like osimertinib, erlotinib and gefitinib block faulty epidermal growth factor receptors that drive tumor growth.
- ALK and ROS1 rearrangements. Targeted by medications such as crizotinib, alectinib and lorlatinib.
- BRAF mutations. Treated with drugs like dabrafenib and trametinib.
- KRAS G12C mutations. Targeted by sotorasib and adagrasib.
Patients taking targeted therapies may experience side effects such as rash, diarrhea, liver irritation or fatigue. These are often more manageable compared to standard chemotherapy. Genetic testing of the tumor is critical before starting targeted therapy, as not all patients have these mutations.
5. Immunotherapy
Immunotherapy helps the body’s immune system recognize and fight cancer cells. The most widely used class of immunotherapy for NSCLC is immune checkpoint inhibitors, which block proteins like PD-1, PD-L1 or CTLA-4 that normally keep immune responses in check. By blocking these checkpoints, T cells can better attack cancer cells.
Examples include pembrolizumab, nivolumab, atezolizumab and durvalumab. Immunotherapy can be given alone or in combination with chemotherapy, especially in advanced or metastatic NSCLC.
Some patients experience long-lasting responses and remission with immunotherapy, but not everyone benefits from it. Side effects are linked to overactive immune responses and can include inflammation of the lungs, colon, thyroid, liver or skin. These are often manageable with corticosteroids or immunosuppressive drugs when caught early.
Combination Approaches
Many NSCLC treatment plans use a combination of these methods. For example, a patient may undergo surgery followed by chemotherapy and immunotherapy, or receive a mix of radiation and targeted therapy. Multidisciplinary teams involving surgeons, oncologists, radiation specialists and nurses work together to customize a plan based on the cancer’s stage and the patient’s health. Always talk to your doctor and medical team to learn more about the best treatment approach for your specific needs.