8 Questions About Chemo and Lung Cancer, Answered
A diagnosis of advanced non-small cell lung cancer (NSCLC) can be overwhelming. But the first step toward gaining your footing is to work with your doctor to come up with a solid treatment plan. These days, there are more treatments than ever for advanced NSCLC, helping more and more people with this disease live for years after diagnosis, according to the American Society of Clinical Oncology (ASCO). One of the most common treatments? Chemotherapy. Here, we’ll explain when and how chemo may be used to treat advanced NSCLC so you know what you may expect.
What Is Chemotherapy?
“Chemotherapy for lung cancer has been a staple treatment for decades and still plays a crucial role in the treatment of our patients,” says Conor Steuer, M.D., assistant professor in the department of hematology and medical oncology at Emory University School of Medicine in Atlanta, GA. Chemo is what’s called a systemic therapy, according to ASCO, which means that the meds, typically given via an IV, enter the blood stream and then destroy cancer cells in the body. Chemo can help people with lung cancer—including those with advanced disease—live longer lives with greater wellbeing, per ASCO.
What Are the Other Types of Therapies for Advanced NSCLC?
In addition to chemotherapy, there are several other potential treatment options for advanced NSCLC—sometimes in combination with chemo (called combination therapy), according to ASCO. These options include radiation therapy and surgery, along with two newer forms of therapy: immunotherapy and targeted therapy. Immunotherapy drugs work by stimulating the body’s own immune system to attack the cancer, while targeted drugs attack a specific molecular change in the tumor, such as a genetic mutation, explains Jeffrey Crawford, M.D., lung oncologist at Duke Cancer Center in Durham, NC.
What Determines the Best Treatment for Advanced NSCLC?
If your NSCLC has spread throughout your body, your doctor will test your tumor to determine whether it has any genetic mutations, says the American Cancer Society. If so, they will likely place you on a targeted therapy drug aimed specifically at that mutation to help block the cancer. They also may test your tumor for a protein called PD-L1. If you test positive, your doctor may suggest certain immunotherapies (sometimes along with chemo) that work well for tumors with this protein, says the American Cancer Society. For cancers that don’t test positive for mutations or PD-L1, different combos of immunotherapy and chemo may be used.
When Is Chemo Used in Advanced NSCLC Treatment?
You may have noticed that chemo kept popping up in that last slide—here’s why: “In recent years, other therapies have grown in importance in treating stage 4 lung cancer patients, such as immunotherapy and targeted therapy, but chemotherapy still has an important role,” explains Dr. Steuer. For example, he says, if someone’s advanced NSCLC does not have a mutation that can be targeted by a targeted therapy, they are usually considered for immunotherapy, often in combination with chemo. Chemo may also be used in those who can’t tolerate immunotherapies or as a second- or third-line treatment for patients whose cancer has progressed on other therapies, he says.
Why Are Chemo and Other Therapies Used Together?
Often, a combination of chemo plus another therapy can be more effective in treating advanced lung cancer than just one therapy on its own. For example, the U.S. Food and Drug Administration approved a combination therapy as the first-line treatment for people with metastatic (stage 4) or recurrent NSCLC for which there is no targeted drug available. This combination, approved in 2020, uses two immunotherapy drugs, Opdivo (nivolumab) and Yervoy (ipilimumab), along with two cycles of chemotherapy. Clinical trials found that this combo was more effective than receiving chemo alone, improving overall survival.
What Are the Side Effects of Chemo?
So if you’re being treated for advanced NSCLC, you’re most likely getting chemo at some point. So what can you expect? Chemotherapy, like all medical treatments, comes with the potential for side effects. Because it’s a systemic treatment, side effects can be throughout the whole body rather than just where the cancer is located. Every chemotherapy regimen is different, says Dr. Steuer, with some drugs being “tougher” than others. But in general, the most common side effects are nausea, fatigue, decrease in appetite, hair loss, increased risk of infection due to low blood cell counts, and gastrointestinal upset, he says.
How Are Chemo Side Effects Managed?
Good news: “Treatment of chemotherapy side effects and toxicity has improved dramatically over the last few decades,” says Dr. Steuer. For example, there are effective drugs to prevent nausea and vomiting, says Dr. Crawford. “We give those medications acutely during chemotherapy, and they can take them later as well,” he explains. To manage appetite issues, working with a dietitian can help, says Dr. Crawford. As for infection risk, your doctor will monitor your blood cell counts and adjust treatment to keep you as healthy as possible. Make sure to tell your doc about any side effects ASAP so they can help you manage them.
What If You Can’t Have Chemo?
Some people aren’t able to tolerate chemotherapy well due to risk of side effects and other factors, according to the American Cancer Society. In these cases, your treatment may include different combinations of therapies. For example, if you’re not in good health, your doctor may choose to give you only one chemo drug instead of two. Or if you can’t have chemo at all, radiation therapy may be a good option. With these advanced cancers, you’re often undergoing several different treatments over time—and your doctor will help personalize your treatment plan to find what works best for you.
The Bottom Line
“With advanced lung cancer, it’s a broad-based treatment approach using all the different options we have to maximize the quality and quantity of life that patients have,” says Dr. Crawford. And often times, chemotherapy is playing a key role in that approach, usually working in combination with other innovative therapies that are more effective than ever. “The field of treatment of lung cancer has improved dramatically over the last 15 years, so there’s a lot of hope,” says Dr. Steuer.
Non-Small Cell Lung Cancer Treatments by Stage: American Cancer Society. (2021.) “Treatment Choices for Non-Small Cell Lung Cancer, by Stage.” https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/by-stage.html
Lung Cancer Treatment Options: American Society of Clinical Oncology. (2020.) “Lung Cancer – Non-Small Cell: Types of Treatment.” https://www.cancer.net/cancer-types/lung-cancer-non-small-cell/types-treatment
FDA Approval of Nivolumab Plus Ipilimumab and Chemo: U.S. Food and Drug Administration. (2020.) “FDA approves nivolumab plus ipilimumab and chemotherapy for first-line treatment of metastatic NSCLC.” https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-nivolumab-plus-ipilimumab-and-chemotherapy-first-line-treatment-metastatic-nsclc