Surgery, radiation, chemotherapy, and targeted treatments—alone or in combination—are used to treat lung cancer. Each of these types
of treatments may cause different side effects, which are discussed in the next section of this booklet.
SURGERY
Most stage I and stage II non-small cell lung cancers are treated with surgery to remove the tumor. For this procedure,
called a lobectomy, a surgeon removes the lobe, or section, of the lung containing the tumor.
Some surgeons use video-assisted thoracoscopic surgery (VATS). For this procedure, the surgeon makes a small incision,
or cut, in the chest and inserts a tube called a thoracoscope. The thoracoscope has a light and a tiny camera connected to a
video monitor so that the surgeon can see inside the chest. A lung lobe can then be removed through the scope, without
making a large incision in the chest.
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CHEMOTHERAPY AND RADIATION
For people with non-small cell lung tumors that can be surgically removed, evidence suggests that chemotherapy after
surgery, known as adjuvant chemotherapy, may help prevent the cancer from returning. Still, questions remain about whether
adjuvant chemotherapy is best for all patients and how much people with different stages of lung cancer will benefit. Research
continues on this topic.
For people with stage III lung cancer, doctors may recommend chemotherapy possibly followed by radiation treatments to shrink
the tumor or surgery to remove what remains of the tumor.
In stage IV lung cancer, chemotherapy is typically the main treatment. It is often combined with radiation.
The chemotherapy treatment plan for lung cancer often consists of a combination of drugs. Among the drugs most commonly used
are:
- Either cisplatin (available under the trade name Platinol as well as generically) or carboplatin (Paraplatin or generic carboplatin)
- Plus docetaxel (Taxotere), gemcitabine (Gemzar), paclitaxel (Taxol and others), vinorelbine (Navelbine and others), or
pemetrexed (Alimta).
There are times when these treatments may not work. Or, after these drugs work for a while, the lung cancer may come back.
In such cases, doctors often prescribe a second course of drug treatment referred to as second-line chemotherapy.
Recently, the findings from an important clinical trial showed significant benefits to starting second-line chemotherapy
right after a first course of chemotherapy, rather than waiting for lung cancer to recur. In this clinical trial, people were
treated with the chemotherapy drug pemetrexed immediately after a first course of chemotherapy—even if there were no
signs that the cancer had come back. In these people, it took much longer for lung cancer to recur than in people who were
not treated with a second course of chemotherapy right away.
For people with small cell lung cancer, chemotherapy, rather than surgery, is usually the treatment of choice
right from the start. Radiation treatment is used as well.
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CHEMOTHERAPY BEFORE OTHER TREATMENTS
Research shows that receiving chemotherapy before radiation or surgery may also help people with lung cancer.
Chemotherapy may:
- Shrink the tumor enough to make it easier to remove with surgery.
- Increase the effectiveness of radiation.
- Destroy hidden cancer cells at the earliest possible time.
And if a tumor doesn't shrink with chemotherapy, the medication can be stopped right away, allowing the doctor to try a
different treatment. In addition, research shows that people with lung cancer are much more able to cope with the side
effects of chemotherapy when it is given before surgery.
Another reason chemotherapy may be given before surgery is to see if it will be beneficial after surgery. Sometimes, a
short trial period of treatment with the drug shrinks the tumor before surgery. If that is the case, then longer treatment
with the same drug after surgery is more likely to benefit the patient.
Because many lung cancer specialists around the world are giving chemotherapy to their patients before surgery, it is
something well worth discussing with your doctor.
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TARGETED TREATMENTS
One of the most exciting developments in lung cancer medicine is the introduction of targeted treatments. These treatments
for lung cancer include:
Erlotinib (Tarceva) A targeted treatment called erlotinib has been shown to benefit some people with non-small cell
lung cancer. This drug blocks a specific kind of receptor on the cell surface—the epidermal growth factor receptor
(EGFR). Receptors such as EGFR act as doorways, allowing substances in that can encourage a cancer cell to grow and
spread. The more receptors on a cell, the more signals the cell receives to grow and multiply. In lung tumors with many
EGFRs, treatment with erlotinib can sometimes slow or block the cancer's growth.
Bevacizumab (Avastin) Just like normal tissues, tumors need a blood supply to survive. Blood vessels grow in
several ways. One way is through the presence of another substance called vascular endothelial growth factor (VEGF). This
substance stimulates blood vessels to penetrate tumors and supply oxygen, minerals, and other nutrients to feed the
tumor. When tumors spread throughout the body, they release VEGF to create new blood vessels.
Bevacizumab works by stopping VEGF from stimulating the growth of new blood vessels. (Because normal tissues have an
established blood supply, they are not affected by the drug.) When combined with chemotherapy, bevacizumab has been shown
to improve survival in people with certain types of non-small lung cancer
such as adenocarcinoma and large cell carcinoma.
Cetuximab (Erbitux) Another targeted treatment still in clinical trials, cetuximab has shown promise in treating
stage IV lung disease. Like erlotinib, cetuximab blocks EGFR. The findings from a recent clinical trial showed that
combining cetuximab with chemotherapy was more effective in treating people with stage IV lung cancer than
chemotherapy alone. Although cetuximab has not been approved for use in treating lung cancer, research with the drug is
ongoing.
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