Chemotherapy once was the only medicine doctors could prescribe to someone with non-small-cell lung cancer (NSCLC). Times have changed. There are not only advances in the chemotherapy itself, but there are new kinds of medications to treat this disease.
One of the newer treatments changes the way certain cancer cells grow or change in your body. Doctors call this targeted therapy. Another boosts your immune system to better fight cancer. It's called immunotherapy.
Just the word may make you think of unpleasant side effects like nausea and vomiting. Although that can still happen, there are better medicines to tame it, says Kenneth Ng, MD, chief of medical oncology at Memorial Sloan Kettering Rockville Centre in New York.
Sometimes chemo causes fatigue, depression, nerve problems, memory problems, or hair loss. They happen because of the way the drugs work.
“Chemotherapy actually kills the cancer cells, but it doesn't only kill cancer cells, it kills normal cells as well,” says Shakun Malik, MD, at the National Cancer Institute's Cancer Therapy Evaluation Program.
But there is some chemo for NSCLC that doesn't cause hair loss, and memory problems can be milder for some people. That’s true for some newer chemo drugs and updated versions of older ones. “It's better compared to before,” Ng says.
You’re likely to get more than one type of chemo drug to start with. That’s routine now. “Combining two to three different chemotherapy drugs works better than giving one chemotherapy drug,” Ng says.
These drugs target cancer cells based on certain types of genetic information and kill them.
Doctors will take a sample of your tumor. Then they’ll see if the cancer cells will respond to one of these drugs. If you’ve never smoked, the odds are better that targeted therapy will work for you.
In 2016, the FDA approved the drug crizotinib (Xalkori) in people with advanced NSCLC whose tumors carry a genetic mutation called ROS-1. The oral medication acts as a protein inhibitor, blocking ROS-1’s activity, which potentially could prevent NSCLC from growing and spreading. This drug has already been used to treat patients with NSCLC whose cancer is caused by a defect in a gene called ALK.
If your tumor has an ALK mutation there are other targeted therapies your doctor will consider. Alectinib (Alecensa) or ceritinib (Zykadia) are now approved for first line treatment of tumors with ALK gene mutations. Brigatinib (Alunbrig) is another treatment options. Some of these therapies may also be helpful in treating tumors with the ROS-1 mutation.
Side effects are usually milder than those that come with chemo. Skin rashes, nail changes, diarrhea, and fatigue are common.
In addition, drugs that target a growth factor receptor (EGFR) help control advanced lung cancer by blocking a signal that tells cells to grow. These medications include afatinib (Gilotrif), erlotinib (Tarceva), necitumumab (Portrazza) and osimertinib (Tagrisso).
In addition, lab made monclonal antibodies target specific markers, called antigens, that are found on tumors. Examples used to treat lung cancer are bevacizumab (Avastin) and ramucirumab (Cyramza).
If your cancer is in a late stage, this new type of medicine can boost your immune system and help it fight cancer cells. The FDA has approved several immunotherapy drugs for lung cancer, including NSCLC. One class is called check point inhibitors because they target the natural checkpoints your body has which trigger how your immune system reacts. The drugs atezolizumab (Tecentriq), durvalumab (Imfinzi), nivolumab (Opdivo), and pembrolizumab (Keytruda) target these checkpoints and basically take the brakes off your immune system so that it can mount a better attack on tumor cells.
You get immunotherapy as an IV infusion every 2-3 weeks at a doctor's office.
Fatigue and achy joints are common. In rare cases, immunotherapy can cause inflammation in the lungs, liver, thyroid, pituitary gland, brain, or colon.
“You're unleashing the immune system to go and attack the cancer,” says George R. Simon, MD, of the University of Texas M.D. Anderson Cancer Center in Houston.
Sometimes it can turn on the body and attack something it isn’t supposed to.
Scientists are studying other ways to use these types of treatments. People with early-stage cancer might get them before they have surgery. Others might take them together with chemotherapy.
Imagine, Ng says -- you’d get chemo to fight the cancer at the same time you take drugs to strengthen your immune system.