Non-Small Cell Lung Cancer – Treatment Options

Surgery. Your doctor surgically removes the tumor from your lung. Surgery may include removing only a part of one lobe, an entire lobe or your entire lung.

WHEN USED: You’re most likely to have surgery when your cancer has not spread farther than your nearby lymph nodes. If it has spread farther, or if surgery cannot fully remove your cancer, your doctor will suggest another treatment instead of surgery or along with it (adjunct therapy).

Radiofrequency ablation. For this procedure, your doctor inserts a thin, needle- like probe through the skin into the tumor. High-energy radio waves heat the tumor to destroy the cancer cells.

WHEN USED: This option may be used for some small tumors located near the outer edge of the lungs, especially if the person can’t tolerate surgery.

Radiation Therapy. This uses high-energy radiation to kill cancer cells. Your doctor may aim the rays at your cancer from outside your body (external radiation). Or your doctor may use a needle or small seed (pellet) to place radioactive material inside your body, near your cancer (called internal radiation or brachytherapy). Radiation treatments generally last a few minutes. You may have treatment five days a week for 5 to 7 weeks, or only 1 to 5 times total if you have newer treatments.

WHEN USED: If your tumor is too big or has spread too far for surgery, your doctor may recommend radiation. You may have radiation therapy in combination with chemotherapy. You could also have it before or after surgery, or to help relieve symptoms.

Chemotherapy. This uses one or more medicines (usually two) to kill cancer cells. You may take chemo medicines as a pill, or your doctor may inject them into your veins. You usually take them in cycles: generally a treatment lasts 1 to 3 days followed by a break, so your body can recover. You may repeat this pattern multiple times in a cycle. One cycle will usually take 3 to 4 weeks. Chemo medicines travel to all parts of your body (systemic therapy) so it’s useful if your cancer has spread. But this means it can also attack healthy cells.

WHEN USED: You may have chemotherapy as your main treatment (sometimes with radiation) if surgery isn’t right for you. Your doctor could also recommend chemo before surgery to shrink a tumor (neoadjuvant therapy) or after surgery to kill any leftover cancer cells (adjuvant therapy). Chemo could also be part of your palliative care plan to help control the cancer and ease symptoms.

Targeted Therapy. These are medicines that can kill some cancer cells without harming healthy cells. You may take it as a pill, or your doctor may inject it into your veins. It’s usually recommended for advanced cancer. There are three main types. While each works differently, they all work like guided missiles to seek and destroy cancer cells:

Medicines that block tumor blood vessel growth (bevacizumab and ramucirumab). These stop VEGF (vascular endothelial growth factor) from working. VEGF is a protein that helps blood vessels form. In order for tumors to grow, they need to form blood vessels to feed themselves. Blocking VEGF starves the tumor cells.
Medicines that block EGFR (erlotinib, afatinib, necitumumab, osimertinib, gefitinib, dacomatinib). These block the signal from EGFR (epidermal growth factor receptor) that tells your cells to grow. They are often used if your lung cancer cells grow too fast because of a change in your EGFR gene.
Medicines that block abnormal ALK protein (crizotinib, alectinib, brigatinib, ceritinib, lorlatinib). These are used if your lung cancer cells have a change in the ALK or ROS1 genes (your doctor tests for it). This change creates an abnormal ALK or ROS1 protein that makes your cancer cells grow and spread. Blocking these abnormal proteins can shrink your tumor.
Medications that block abnormal BRAF protein (dabrafenib, tramatinib). These are used in combination to treat cancers with cells that make an abnormal BRAF protein. This stops the cancer from using the altered BRAF to grow.

WHEN USED: If you have advanced NSCLC, you may have targeted therapy, either alone or with chemo. You’re most likely to have targeted therapy if other treatments haven’t worked. However, your doctor may suggest this first if you have changes in certain genes.

Immunotherapy (Pembrolizumab, atezolizumab, nivolumab, durvalumab). These newer medicines are injected into your veins by your doctor every two or three weeks. They are also called immune checkpoint inhibitors (or just checkpoint inhibitors), and they help your body’s immune system better fight cancer cells. These medicines target parts of cells called “checkpoints” that need to be turned off or on in order for your immune system to respond to a possible threat.

Immunotherapy medicines that treat lung cancer target the checkpoint proteins PD-1 or PD-L1. PD-1 is found on immune system fighter cells called T cells. PD-L1 is found on some normal and cancerous cells. These proteins help stop your immune system from attacking your cells—including cancer cells.

Checkpoint inhibitors keep PD-1 or PD-L1 from working so your immune system can recognize and attack the cancer cells. This is like taking the brakes off your immune system. It unleashes its full power to fight your cancer.

WHEN USED: You may have immunotherapy if you have certain types of advanced lung cancer. Pembrolizumab can be used as the first treatment for some NSCLC patients, with or instead of chemotherapy.

Is Your Treatment Working?

Your doctor will schedule tests to see if your treatment is working. It can take two full cycles, or about 2 to 3 months, before it starts to work. You may also need to try a few different treatments or combinations to find the right one. If you don’t get the results you’re hoping for right away, don’t give up. Work with your doctor to understand your options.

Palliative Care

How much do you know about palliative care? If you’ve just been diagnosed, palliative care will probably be part of your treatment plan.

What is palliative care? The goal of this kind of treatment is not to cure your cancer. The goal is to treat the symptoms and side effects of your cancer and treatment— this includes mental, social and spiritual help.

Is palliative care different from hospice? Like hospice, palliative care focuses on patient comfort and support. But palliative care is given much earlier in your diagnosis and is given alongside cancer-fighting treatment. Hospice care happens toward the end of life, when cancer treatments are no longer controlling the disease.

What issues does palliative care treat? Palliative care is a broad treatment that addresses:

physical symptoms like pain, fatigue and nausea
emotional symptoms like depression, anxiety and fear
practical concerns like insurance questions, employment issues and financial worries
spiritual concerns like questioning your faith, trying to understand why this is happening to you, exploring religion and trying to find a sense of peace or acceptance

Where do I receive palliative care? You can receive palliative care at different places like a hospital, cancer center, your home or a specialized facility. You’ll often receive care from a team of specialists.

If you have questions about how to include palliative care as part of your cancer treatment, talk to your doctor.

TIP: Some complementary or alternative treatments—like acupuncture, massage and supplements—might help ease your symptoms. But others can be dangerous. And none can help cure your cancer or take the place of your doctor’s treatment. So always talk to your doctor before trying something new—no matter how harmless it seems.