by Mona Jhaveri - October 27, 2021

Lung cancer is one of the most common cancers, but it is also one of the deadliest. The outlook for people with lung cancer greatly varies based on various factors, including what subtype they have – non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC).

Lung cancer treatments are diverse and depend on many things, such as cancer subtype, stage of disease, patient age, comorbidity, smoking status, and performance status.

Surgery is the treatment option that offers the best cure rates for many patients. If surgery isn’t an option, then chemotherapy can be used to shrink tumors before other treatments are considered. Radiation therapy may be another useful option if surgery or chemo isn’t possible. Recently, immune checkpoint inhibitors are drugs that have been successfully employed for lung cancer treatment.

In this blog post, we’ll talk about the current treatments and breakthrough therapies for lung cancer.

Surgery

Surgery is a suitable option for some early-stage non-small cell lung cancer (NSCLC) patients. Surgery can remove all or part of the tumor, and sometimes lymph nodes are removed to see if they contain signs of disease.

This is not a good treatment option for small-cell lung cancer (SCLC) since it is more spread out by the time it is diagnosed. In fewer than 1 in 20 patients, small-cell lung cancer is found as a single tumor only. 

New forms of surgery are constantly being developed for lung cancer patients. One of these is video-assisted thoracic surgery (VATS), a minimally invasive surgery using video cameras, small incisions, and thoracic instruments.  VATS lobectomy for lung cancer patients aims to provide the same benefits as open-lung biopsy while decreasing associated morbidity risks and increasing survival.

Another breakthrough in surgical methods is robotically-assisted thoracic surgery (RATS), a minimally invasive surgery using robotic arms. This technology allows surgeons to remove tumors in hard-to-reach areas of the lung, such as those near blood vessels or airways that are difficult to see with the naked eye.

Radiation Therapy

Radiation therapy works by bombarding tumors with high-energy X-rays or particles, damaging cancerous cells’ ability to reproduce and/or slowing their growth speed and disease progression.

Radiation is a common treatment for lung cancer patients who cannot have surgery or chemotherapy because of other medical conditions. However, it is also a good treatment option for patients who have early-stage NSCLC and want to avoid surgery due to the invasiveness of the procedure or an unwillingness to undergo such a major intervention.

Radiation therapy can be delivered in several ways:

  • External beam radiation therapy
  • Internal radiotherapy (brachytherapy)
  • Stereotactic body radiotherapy, often used in SCLC treatment

The side effects of radiation therapy depend highly on the area being treated and the type of treatment given. If a tumor is near important structures in the lung, such as airways or veins, radiation therapy can have severe long-term consequences. The primary reason for this is that radiation therapy affects not only cancer cells but also normal cells.

Chemotherapy

Chemo is usually the treatment of choice for SCLC because surgery and radiation aren’t very effective when the disease is dispersed. It is also used to treat locally advanced or metastatic NSCLC, often in conjunction with surgery and radiation therapy.

In SCLC treatment, the following chemotherapy drugs are often used:

  • Cisplatin + etoposide
  • Etoposide + carboplatin
  • Cisplatin + irinotecan
  • Irinotecan + carboplatin

In NSCLC treatment, patients might be given these chemotherapy drugs:

  • Cisplatin
  • Paclitaxel
  • Carboplatin
  • Docetaxel
  • Pemetrexed
  • Gemcitabine
  • Etoposide, and more

Chemotherapy can be used on its own or in combination with other types of treatment.

Sometimes, chemo is used as the first-line therapy instead of other treatments like surgery and radiation. The goal is to shrink tumors before using other approaches like targeted drug therapies, radiofrequency ablation (RFA), or immunotherapy.

Immunotherapy

The development of immunotherapy for lung cancer patients has been a recent breakthrough in the fight against this disease. Immunotherapy is considered both targeted therapy and immuno-oncology, but it works by allowing your immune system to target cancer cells specifically. This treatment method can also be combined with other treatments like chemotherapy and radiation therapies (or even surgery).

Immune checkpoint inhibitors are drugs that block proteins that generally suppress your immune system and stop the body from attacking specific cells (like cancer cells). These drugs bolster a patient’s immune response against tumors.

Examples of checkpoint inhibitors for NSC lung cancer treatment include:

  • Nivolumab, cemiplimab, pembrolizumab
  • Atezolizumab
  • Durvalumab

Atezolizumab and durvalumab are also used in treating SCLC.

Targeted Therapy

Targeted therapy drugs target specific molecular markers in cancer cells. This is different from chemo because targeted therapy focuses more on the differences within a tumor rather than all over the body. Depending on the patient’s needs, these therapies may be used alone or with other treatments like chemotherapy, radiation therapy, surgery, and/or immunotherapy.

For NSCL, targeted therapies may include:

  • EGFR (epidermal growth factor receptor) inhibitors – gefitinib
  • ALK (anaplastic lymphoma kinase) inhibitors – crizotinib, ceritinib
  • KRAS inhibitors – sotorasib
  • BRAF inhibitor – dabrafenib, and others

Unfortunately, there are no studies suggesting the effectiveness of targeted therapy drugs on SCLC.

Radiofrequency Ablation

Another treatment method that can only be used in NSCLC is radiofrequency ablation (RFA). This process heats the tumor to kill it. It is sometimes used in combination with chemotherapy or radiation therapy, but not always.

This procedure is typically performed in an outpatient facility under local anesthesia. A radiofrequency probe is inserted into the tumor through a small incision. The tip of this device sends out heat to kill cancer cells, leaving healthy lung tissue intact. It may take several treatments before achieving the desired results, especially if it is the first time using RFA for NSCLC treatment options.

This option is best for small tumors located at the outer edge of the lungs. RFA is also used in cases where surgery isn’t possible due to location or other factors like patient health and age.

Treatment Side Effects

Unfortunately, cancer treatments cause side effects that vary from patient to patient. Some common ones include fatigue and weakness, nausea/vomiting, diarrhea, mouth sores or ulcers (which may last up to several weeks), hair loss (although this is temporary for most people), changes in taste sensation or smell perception, skin rashes after drug injections with chemotherapy or biotherapy, and more.

Lung cancer treatment could also cause long-term side effects, such as pain, breathing problems (like shortness of breath), and changes in the heart.

It is essential to talk with your healthcare provider about these issues because they may be severe enough to require medical care or treatment before finishing the course of cancer therapy.

Lung cancer patients should also be aware that treatment options may change depending on their specific case. For example, surgery might not always be required to treat lung cancer if it can’t be found or reached by a surgeon. Chemotherapy is often used as a first-line treatment in some cases as well.

Targeted drug therapies and immunotherapy may be used independently or combined with other treatments like chemo, surgery, radiation therapy, RFA (in NSCLC), and more, depending on the patient’s health condition at diagnosis time.

Conclusion

Thanks to significant advances in research, lung cancer treatment options have come a long way in recent years. Treatment types and combinations vary depending on the type of lung cancer (NSCLC or SCLC) as well as patient age, health condition, personal preferences, previous medical history, tumor size at diagnosis time, among other factors.

Breakthrough drugs are emerging to treat specific subtypes of lung cancer. They include targeted therapies and immunotherapy drugs that are given alone or along with other treatment options like chemo, surgery, radiation therapy, RFA (in NSCLC), among others depending on the patient’s health condition at diagnosis time.

The search for more effective, safer, and less invasive treatments is also ongoing in the lung cancer research community. You can help out by donating to our active campaigns and sharing our posts with your family and friends.

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