Non-Small Cell Lung Cancer - Chemotherapy Treatments

Side Effects

Side effects of any chemotherapeutic regimen are common, are more severe with higher doses, and increase over the course of treatment, though some trials suggest that toxicities can be reduced by administering the drugs for shorter durations without loss of cancer-killing effects. Common side effects include the following:

Nausea and vomiting. Drugs known as serotonin antagonists, especially ondansetron (Zofran), can relieve these side effects in nearly all patients given moderate drugs and most patients who take more powerful drugs. In one study, a combination of dexamethasone (a steroid) with ondansetron taken within 24 hours of chemotherapy achieved either a major or complete reduction in nausea and vomiting.
Diarrhea.
Temporary hair loss.
Weight loss.
Fatigue.
Anemia. Anemia is common in lung cancer. It can be treated with transfusions or with injections of erythropoietin, an agent that stimulates red blood cell production. Erythropoetin is available as epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp), which requires fewer injections. These agents improve well-being and quality of life. Trials are in progress to determine if they may have survival benefits as well.
Depression.

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These side effects are nearly always temporary. Most patients are able to continue with normal activities for all but perhaps one or two days per month.

Serious complications can also occur and may vary depending on the specific agents used. They include the following:

Increased chance for infection from suppression of the immune system.
Severe drops in white blood cells (neutropenia). Certain agents, such as taxanes, pose a higher risk for this than other chemotherapeutic drugs. White blood cell count may be improved with the addition of a type of drug called granulocyte colony-stimulating factor (either filgrastim and lenograstim).
Liver and kidney damage. Amifostine (Ethyol) reduces the risk for kidney damage in patients taking repeated regimens of cisplatin-based therapy. It is also a radioprotector; that is, it helps prevent severe effects in the esophagus from radiotherapy with or without chemotherapy.
Abnormal blood clotting (thrombocytopenia).
Allergic reaction, particularly to platinum-based agents. (A simple skin test is under investigation that may identify people with a potential allergic response.)

Second-Line Chemotherapy

Second-line chemotherapy is used for patients whose cancers have recurred after first-line chemotherapy. Some experts believe that longer survival rates for advanced lung cancer being observed for the past five years may be due to these agents. Because platinum-based agents are most often used initially in most cases, they are not beneficial for second-line therapy. The following are commonly used second-line agents.