New Approaches to Advanced NSCLC Treatment
So you’ve been diagnosed with advanced non-small cell lung cancer (NSCLC). That’s a mouthful, to be sure, but one thing you know: It doesn’t sound good. NSCLC is the most common kind of lung cancer. (Up to 85% of lung cancers may be classified as NSCLC). The cancer can start in different types of cells in the lung and its airways, including those that secrete mucus—a substance that’s important for trapping smoke, pollen, and other particles we inhale. It can also begin in cells that line the airways or lung cells directly. When cancer spreads to other parts of the body, it’s referred to as advanced NSCLC.
New Treatments Offer Hope
It’s natural to be frightened, but know this: There is a lot of reason to feel hopeful if you are diagnosed with NSCLC right now. Today, many people diagnosed with NSCLC are surviving five years or longer and living a satisfying life. That’s because in the last few years the medical profession has made great strides in determining (and targeting with medication) genetic changes (mutations) in the tumors responsible for the cancer as well as being able to mobilize the immune system to battle cancerous cells.
How Targeted Therapy Works
A tumor biopsy can reveal if there is a genetic change (mutation) in the cells, allowing them to grow abnormally. These are referred to as driver mutations. “As their name suggests, driver mutations ‘drive’ the cancer cells to divide and spread,” says to Pradnya Patil, M.D., a doctor at the Taussig Cancer Institute at the Cleveland Clinic in Ohio. Targeted therapies are designed to switch off the driver function of that particular mutation, Dr. Patil says. Depending on what abnormal gene or protein is found in the tumor, a specific drug may effectively stop or slow the cancer growth.
Complications of Targeted Therapy
Side effects depend on the specific drug prescribed to influence the tumor’s growth factors. “Because your skin and gastrointestinal tract often have the same growth factors that your cancer may have, a rash and diarrhea are common with targeted therapies,” says Amy Cummings, M.D., clinical instructor of hematology/oncology at the David Geffen School of Medicine at UCLA. Other side effects include nausea, dry or itchy skin, and loss of appetite. If you have any serious side effects such as changes in your vision, seizures or you bruise easily, contact your physician.
Treatments That Target Blood Vessels
Another type of targeted therapy aims at the tumor’s environment, specifically its blood supply. After all, tumors grow rapidly, requiring the formation of new blood vessels which deliver necessary oxygen and nutrients (angiogenesis). Treatment that curtails this process, called anti-angiogenic therapy, attempts to starve the tumor, essentially killing it. Two such drugs are bevacizumab and ramucirumab, which both target a protein (VEGF or vascular endothelial growth factor) that’s needed for new blood vessels to form.
Side Effects of Anti-Angiogenesis Meds
Side effects vary greatly with the specific drug prescribed. Some of the more common side effects include a cough, dry mouth, loss of appetite, constipation, headache or symptoms of a cold such as a stuffy or runny nose. Serious complications include a wound that won’t heal, ankle or foot swelling, difficulty breathing, or dark urine. Of particular concern is an increased risk of blood clots or excessive bleeding. These may present as any of the following symptoms: bloody or black stool, coughing up blood, slurred speech, difficult with your balance or chest pain.
How Immunotherapy Works
“The activity of immunotherapy...is based on the ability to restore the immune system against cancer cells,” says Marina Chiara Garassino, M.D., director of the thoracic program at University of Chicago Medicine. In some cases, as with the drug Opdivo (nivolumab), your body’s special immune cells (known as T cells) are activated to attack cancer cells in your body. In other treatments, certain proteins are blocked, thereby slowing or stopping tumor growth, especially in people who have a high percent of tumor cells with this particular protein.
Side Effects of Immunotherapy
“Immunotherapy’s side effects are caused by the immune system attacking normal tissue,” says Dr. Cummings. The side effects depend on the specific drug prescribed but may include a skin rash, dryness, or blistering. Fatigue, nausea, fever, loss of appetite, or diarrhea are also common. If you have any of these side effects, such as shortness of breath, a worsening cough, yellowing of the skin or eye, severe abdominal pain, or black stools, contact your doctor. These can indicate an inflammation of the lung, liver, or large intestine.
Understanding Combination Therapy
Your doctor may prescribe two immunotherapy drugs or one of those plus chemotherapy. This is referred to as combination therapy. (A combination of drugs can result in beneficial synergistic effects compared with giving just a single drug.) Combining immunotherapy treatments with chemotherapy not only speeds up the treatment process, “there is also a higher chance of a cancer responding or shrinking,” says Naomi Fujioka, M.D., a medical oncologist at the University of Minnesota Medical School in Minneapolis.
Combination Therapy Complications
Combination therapy can be accompanied by a wider array and more severe side effects, including pneumonia, kidney injury, anemia, liver damage or respiratory failure. The potential for serious side effects means this therapy may not be first choice for people who are frail, over 70, or have other health conditions such as heart disease or diabetes. On the other hand, combination therapy also holds much promise for advanced NSCLC, so talk with your doctor to see if it’s an option for you.
Driver Mutations: Rhode Island Medical Journal. (2015.) “NSCLC: An Update of Driver Mutations, Their Role in Pathogenesis and Clinical Significance.” http://www.rimed.org/rimedicaljournal/2015/10/2015-10-25-onc-black.pdf
New Targeted Therapy: New England Journal of Medicine. (2020.) “KRAS G12C Inhibition with Sotorasib in Advanced Solid Tumors.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571518/
Combination Therapy: Expert Review of Anticancer Therapy. (2019.) “The role of combination chemo-immunotherapy in advanced non-small cell lung cancer.” https://pubmed.ncbi.nlm.nih.gov/31188040/