When Chemotherapy Is Used
Chemotherapy is the main treatment for small-cell lung cancer (SCLC), but doctors may also use it before or after surgery, or instead of surgery, in non-small-cell lung cancer (NSCLC).
- Adjuvant therapy is chemo given after lung cancer surgery to treat any remaining cancer.
- Neoadjuvant therapy is chemo given to shrink the tumor before surgery.
Even elderly people with lung cancer can have this treatment. If you’re unable to have surgery for some reason, you may have chemotherapy along with radiation therapy to shrink your tumor.
Chemo and Radiation
Chemotherapy is often used along with radiation therapy to treat lung cancer. Together, chemo drugs and radiation may work better to destroy your cancer cells. In some people with lung cancer, chemo can keep your tumor small so that the radiation can work better to destroy it. It may also keep your cancer cells from growing back after radiation therapy.
While chemo and radiation therapy used together can be a powerful weapon against lung cancer, this combination can have strong side effects.
Chemo for SCLC
Up to 15% of people with lung cancer have small-cell lung cancer.
If your SCLC is at a limited stage, you’ll get chemotherapy and radiation therapy together to shrink your tumor.
If your SCLC is at an extensive stage and has spread, you’ll get chemotherapy alone. That’s because radiation is beamed directly to your tumor. It doesn’t work if your cancer is widespread.
SCLC chemo usually includes etoposide (Toposar, Vepesid) along with a platinum agent like cisplatin (Platinol) or carboplatin (Paraplatin). This is called the EP regimen. If your SCLC is extensive-stage, you may also have the EP regimen, but another option is combined carboplatin and irinotecan (Camptosar).
Chemo for NSCLC
Up to 90% of people with lung cancer have non-small-cell lung cancer. You may have chemo either before or after surgery for NSCLC. Even if your doctor has taken out your tumor and you’ve had radiation therapy, it helps to kill cancer cells that may have spread to other parts of your body.
For people with NSCLC, chemo after surgery may help keep your cancer from coming back, especially if you have stage II or stage III lung cancer. If you have stage III cancer that your doctor can’t treat with surgery, you may have it along with radiation. If your NSCLC is stage IV, chemo is the main treatment, although you may have radiation too to help ease your symptoms.
NSCLC chemotherapy usually includes a combination of cisplatin and carboplatin plus either docetaxel (Taxotere), gemcitabine (Gemzar), paclitaxel (Taxol), pemetrexed (Alimta), or vinorelbine (Navelbine). If your cancer returns after your first course of chemo, a different chemo may or may not be recommended or helpful.
Chemo Treatments: What to Expect
For lung cancer, chemotherapy is usually an intravenous (IV) treatment. You may get a quick shot into your vein or an infusion of the drug through a tube, which can take longer. You’ll get it either in your doctor’s office, clinic, or hospital. You rest while the drugs drip into your vein.
You get chemo in cycles of 3 to 4 weeks. Between cycles, you can rest and recover. You may take your drug only once a week or over a few days of each cycle. If your cancer is advanced, you may need four to six cycles of treatment.
Chemo Side Effects
Chemotherapy drugs can have many side effects. Which ones you have depend on the drug, dose, or the length of your treatment. They can include:
- Hair loss
- Mouth sores
- Loss of appetite
- Weight loss
- Greater risk of infection
- Easy bleeding
Cisplatin, vinorelbine, docetaxel, and paclitaxel may also cause a painful side effect called peripheral neuropathy. You may feel pain, burning, tingling, weakness, or cold sensitivity in your hands or feet. This usually goes away after you’re finished with chemo.
How to Ease Chemo Side Effects
Side effects of chemo usually go away after your treatment is complete.
Talk to your doctor about your side effects to see if you can try anything to relieve them, such as:
- Cooling or cold caps that you can wear during chemo to stop or lessen hair loss
- Drugs to treat nausea or vomiting
- Ginger or peppermint teas or candies to also ease chemo-related nausea
Chemo isn’t the only drug used to treat lung cancer these days. Newer targeted antibodies and immunotherapy drugs may be used instead in some people.
Checkpoint inhibitors are a new type of immunotherapy that uses your own immune system to fight lung cancer and even wipe it out. Immunotherapy now may be the first lung cancer treatment for some people instead of chemo.