Chemotherapy For Lung Cancer

Overview

Every year, around 43,000 people in the UK are diagnosed with lung cancer. It is one of the most frequent and fatal cancers.¹ Lung cancer occurs when cells in your lungs have a mutation, which is a change in your DNA sequence. The uncontrolled growth of cancer cells leads to the formation of a tumour, which will destroy the surrounding healthy lung tissues. 

Lung cancer can happen when you are exposed to dangerous chemicals that you breathe for a long period of time, such as from smoking. However, it can also occur in people with no known exposure to toxic chemicals. Besides the environmental factors, there are inherited and acquired mechanisms that contribute to your susceptibility to developing lung cancer. 

The specific treatment plan for lung cancer depends on its type, stage, and your overall health. The main treatment modalities include:

• Surgery
• Chemotherapy
• Radiation therapy
• Targeted therapy
• Immunotherapy

Chemotherapy plays a crucial role in lung cancer treatment; it destroys cancer cells throughout the body, minimising the risk of recurrence and improving survival rates.² 

When is chemotherapy used?

• Before surgery (neoadjuvant chemotherapy): Neoadjuvant chemotherapy may be used to shrink a tumour so that it can be removed with less invasive surgery.
• After surgery (adjuvant chemotherapy): As adjuvant chemotherapy, chemotherapy drugs will kill any cancer cells that may have been left behind or spread but are not visible on imaging.
• Locally advanced non-small cell lung cancer (NSCLC): For lung cancer that has spread to nearby tissues but has not yet spread to other parts of the body,  chemotherapy combined with radiation therapy is sometimes used as the main treatment or for patients who aren't well enough for surgery.
• Metastatic (stage IV): Chemotherapy may be given to treat NSCLC that has progressed to places other than the lung.

Types of lung cancer and the chemotherapy given 

Small cell lung cancer (SCLC)

SCLC is a lung cancer type that is more aggressive and tends to spread quickly. Treatment for SCLC typically uses chemotherapy and radiation therapy. Surgery may be an option for early-stage SCLC, but it is less commonly used than NSCLC because SCLC is likely to spread outside the lung by the time of diagnosis.¹

• Limited disease: combinations include EP (cisplatin and etoposide) or carboplatin and etoposide.
• Extensive disease: usually combined with immunotherapy drugs. For instance, carboplatin and etoposide combined with atezolizumab or durvalumab, or cisplatin and etoposide with durvalumab.
• If the cancer returns, further treatment options will depend on the situation. Treatments may include carboplatin and etoposide, CAV (cyclophosphamide, doxorubicin, vincristine), topotecan, lurbinectedin, paclitaxel, temozolomide, irinotecan, or gemcitabine with or without carboplatin.

Non-small cell lung cancer (NSCLC)

NSCLC grows and spreads more slowly than SCLC but can still be a serious disease. For early-stage NSCLC, surgery is typically the primary treatment, followed by chemotherapy or radiation therapy to help prevent the cancer from coming back. For advanced NSCLC, a combination of surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy may be used.¹

• Early-stage treatment: Cisplatin or carboplatin, often combined with pemetrexed, vinorelbine, gemcitabine, paclitaxel, or docetaxel.
• Advance or metastatic NSCLC:
  • Single chemotherapy drug: Considered for those who may not tolerate combination chemotherapy well or are in poor overall health.
  • Targeted therapy or immunotherapy: This may be given in conjunction with chemotherapy for some individuals with advanced lung cancer.

How is chemotherapy given?

Chemotherapy for lung cancer is typically given intravenously (IV) in cycles, either as a quick injection or an infusion. A slightly larger IV is often required for chemo drug administration, such as central venous catheters (CVCs), central lines, or central venous access devices (CVADs). These devices are used to administer medicines, blood products, nutrients, or fluids into your bloodstream. They can also be used to take out your blood for testing purposes.

In chemo, you will also hear the term “treatment cycle”. It means you take the drug for a set period, and then followed by a break. For example, you take a chemo drug every day for a week and then not take it for two weeks. These three weeks in total are called one cycle of treatment. Treatment cycles usually last 3 or 4 weeks, depending on the drug that is used. Some chemotherapy medicines are only given once at the start of the treatment cycle. While others are taken for a few days in a row or once a week. 

After finishing one cycle, the chemo plan starts over again for the next round. Adjuvant and neoadjuvant chemotherapy lasts about 3 to 4 months. The duration of advanced lung cancer treatment depends on effectiveness and side effects. Initial chemo combinations for advanced cancers typically last 4 to 6 cycles.

Some doctors recommend maintenance therapy, which is a continued treatment with a single chemotherapy drug for those with positive responses or stable conditions. If initial treatment fails, second-line options may include a single chemo drug like docetaxel or pemetrexed or a targeted therapy or immunotherapy drug. 

You can get chemotherapy at the cancer clinic or hospital, often sitting for a few hours. Bring things to do, like books or electronic devices. You can have someone with you during the chemo. Some treatments span several days, and you might use a portable pump at home. Certain chemotherapy treatments need a hospital stay, sometimes overnight. Some hospitals offer at-home chemo – ask your doctor for details.

Side effects of chemotherapy

The most common side effects of chemotherapy include:

• Fatigue
• Nausea, vomiting, diarrhoea, or constipation
• Breathing problems
• Infection
• Bleeding
• Anaemia
• Hair loss
• Changes in sexual functioning and fertility 

Chemotherapy can also lower white blood cell counts, which increases the risk of infection. A study on patient perspectives and side effects experienced on chemotherapy for non-small cell lung cancer found that the majority of patients were affected by adverse effects such as fatigue, exhaustion, loss of hair, and vomiting.

The side effects of chemotherapy for lung cancer happen because chemotherapeutic agents target not only cancer cells but also other rapidly multiplying cells in the body that will cause unpleasant side effects.

It's important for you to know and discuss potential side effects with your doctor before beginning treatment. Receiving appropriate supportive care to manage these effects is essential to improve your quality of life during treatment.^3,4

What should I do after a chemo? 

After your treatment, you'll have regular check-ups with your doctor. It's normal to feel a bit nervous before these appointments. It can be helpful to talk to your family, friends, or a support organisation for encouragement. Everyone copes with illness and feelings in their own way. Talking to your loved ones or your doctor can be comforting. 

As you recover, consider making positive changes like eating well and staying active, even if you already lead a healthy lifestyle. These small adjustments can boost your well-being and aid in your body's recovery.

FAQs

What is a person's life expectancy with lung cancer?

Life expectancy depends on many factors. But, generally, for people in England with lung cancer, around 40% will survive one year or more, 15% will survive their cancer for five years or more, and 10% will survive for ten years or more.

What stage of lung cancer is chemotherapy used for?

Chemotherapy can be given to lung cancer patients at various stages depending on several considerations, including the lung cancer type, its stage, and the overall condition of the patient.

How long can chemotherapy prolong the life of a lung cancer patient?

The duration of survival rate prolongation will vary based on the individual’s cases. A study shows first-line chemotherapy for individuals with non-small cell lung cancer can prolong survival rate by 2-3 months. It will reduce patients’s symptoms and improve quality of life.¹² Other research shows that the duration of life after chemotherapy for advanced non-small cell lung cancer is typically between 6-12 months.⁵

At what stage is lung cancer most curable?

Early stages of lung cancer (stages 0 and 1) have a better prognosis than later stages (stages 2, 3 or 4).⁶

Where does lung cancer usually spread first?

The common areas for the spreading of lung cancer are nearby lymph nodes or distant lymph nodes.

Is chemo worth it for lung cancer?

Chemotherapy can be an effective treatment for lung cancer, especially in the early stages of the disease. However, it also has numerous side effects, which can vary in severity from person to person. The decision of whether chemotherapy is worth it for lung cancer is personal and complex. You should consult with healthcare professionals who can thoroughly assess the situation and discuss the potential risks and benefits of chemotherapy.⁶

How many rounds of chemotherapy are normal for lung cancer?

Typically, it is four to six cycles.

Summary

Chemotherapy is one of the most crucial treatments for lung cancer patients. The specific treatment plan for lung cancer is tailored to your needs, considering the type of cancer you have, the stage, and your overall health. Advancements in chemotherapy and other treatment options have given lung cancer patients a fighting chance, and the path to recovery begins with your courage to do the treatment.