If you can't get surgery for your lung cancer -- what doctors call "unresectable" -- it doesn't mean you don't have any treatment options. There are other ways to slow your cancer and ease the symptoms.
Your doctor may suggest chemotherapy, radiation, immunotherapy, targeted therapies, and other treatments. A lot depends on the type of lung cancer you have and where in your body it has spread.
Chemotherapy uses medicine to stop cancer cells from growing and dividing. It's the main treatment for most people with small-cell lung cancer. You might also get it if you have non-small-cell lung cancer that has spread to other places in your body.
Doctors usually treat lung cancer with a combination of two or more chemo drugs. You take these medicines by mouth or get them through a vein.
You'll get the medicine every day for a few days. Then you'll have a rest period to give your body time to recover. Each treatment and rest period is called one cycle. One chemo cycle lasts 3 to 4 weeks.
It uses high-energy X-rays to kill cancer cells. Radiation can treat tumors that have spread to your brain or other parts of your body.
Radiation also eases symptoms like pain, coughing, and shortness of breath. And it can shrink a tumor that's blocking your airway.
Usually a machine delivers the radiation to the tumor from outside your body. You'll have radiation sessions 5 days a week for 6 to 7 weeks.
Newer techniques like intensity modulated radiation therapy (IMRT) use a computer to send a more precise beam of radiation. This does less damage to healthy tissues around the cancer.
Stereotactic body radiation therapy (SBRT) may be an option if your lung cancer is in an early stage and your doctor doesn't think surgery is a good idea for you. SBRT uses focused beams to deliver high doses of radiation to your tumor.
These treatments block proteins and other substances that lung cancer cells need to grow. Targeted therapies can sometimes help treat your cancers if you've already had chemotherapy and it hasn't helped. One advantage is that they may have fewer side effects than chemo. But they do carry some significant risks. Your doctor will let you know if they’re a fit for you.
Some targeted drugs block the growth of new blood vessels in tumors. These include:
- Bevacizumab (Avastin)
- Ramucirumab (Cyramza)
Other drugs deal with gene changes that can cause cancer. Your doctor will check to see if you have one of these gene changes, also known as mutations:
Epidermal growth factor (EGFR). This protein affects the growth and spread of cancer cells.
About 10% of people with non-small-cell lung cancer have a change in the EGFR gene. It helps cause lung cancer cells to multiply faster.
There are several drugs called tyrosine kinase inhibitors (TKIs) that target EGFR gene changes.
- Afatinib (Gilotrif)
- Amivantamab-vmiw (Rybrevant)
- Dacomitinib (Vizimpro)
- Erlotinib (Tarceva)
- Gefitinib (Iressa)
- Osimertinib (Tagrisso)
Necitumumab (Portrazza) is a monoclonal antibody that targets EGFR gene changes. It is sometimes used to treat a certain type of lung cancer called squamous cell.
Anaplastic lymphoma kinase (ALK). This gene mutation helps lung cancer cells grow and spread more quickly.
Drugs that block ALK include:
- Alectinib (Alecensa)
- Brigatinib (Alunbrig)
- Ceritinib (Zykadia)
- Crizotinib (Xalkori)
- Entrectinib (Rozlytrek)
- Lorlatinib (Lorbrena)
ROS-1. About 2% of non-small-cell lung cancers have changes to the ROS-1 gene. Some of the drugs that block ALK can also help treat people who have this gene change.
BRAF. Cancer cells with this gene mutation grow more quickly than usual. Drugs that target BRAF include:
- Dabrafenib (Tafinlar)
- Trametinib (Mekinist)
MET (mesenchymal-epithelial transition) gene change. Capmatinib (Tabrecta) is also a kinase inhibitor and is currently the only drug approved to treat this gene mutation. It works to stop growing and spreading to other parts of the body.
KRAS (Kirsten rat sarcoma) gene mutation. This gene helps in the production of the K-Ras protein instructions which helps cells grow and multiply. The first approved targeted therapy for tumors with any KRAS mutation is sotorasib (Lumakras).
Your doctor may suggest you get two or more treatments together, which is called combination therapy. Chemoradiotherapy, for instance, combines chemotherapy and radiation therapy. You can have these two treatments at the same time, or one after the other. Chemo plus radiation kills cancer better than either treatment alone, but it can also lead to more side effects.
If you have late-stage lung cancer, you may need to take a targeted therapy drug along with chemotherapy.
This treatment uses drugs to help your immune system -- your body's defense against germs -- work better to find and kill cancer cells.
Your doctor may talk to you about a type of immunotherapy called checkpoint inhibitors. Checkpoints are substances on the surface of your body's cells. They tell your immune system they're "friendly" to prevent it from attacking them.
Sometimes cancer cells also hide behind checkpoints. Checkpoint inhibitor drugs remove the cancer cells' cover so your immune system can find them.
Checkpoint inhibitors that treat lung cancer include:
- Atezolizumab (Tecentriq)
- Durvalumab (Imfinzi)
- Nivolumab (Opdivo)
- Pembrolizumab (Keytruda)
Radiofrequency Ablation (RFA)
This treatment may be an option if you have a small tumor in the outer part of your lung. RFA delivers an electric current through a needle to your lung. The current creates heat that destroys the cancer cells.
Palliative therapy eases your cancer symptoms and makes you more comfortable. You get this care along with your other treatments. It won't stop your cancer from growing, but it can help you feel better.
Examples of palliative treatments include:
- A procedure to drain fluid from around your lungs or heart
- Laser surgery or light-based therapy to shrink a tumor that's blocking your airway
- Medicine to curb pain, nausea, or coughing
- Oxygen to help you breathe more easily
American Cancer Society: "Chemotherapy for Non-Small Cell Lung Cancer," "Chemotherapy for Small Cell Lung Cancer," "Immunotherapy for Non-Small Cell Lung Cancer," "Palliative Procedures for Non-Small Cell Lung Cancer," "Radiation Therapy for Non-Small Cell Lung Cancer," "Radiofrequency Ablation (RFA) for Non-Small Cell Lung Cancer," "Surgery for Non-Small Cell Lung Cancer," "Targeted Therapy Drugs for Non-Small Cell Lung Cancer."
American Lung Association: "Supportive (Palliative) Care for Lung Cancer."
Lungevity: "Targeted Therapy."
Medscape: "Non-Small Cell Lung Cancer Treatment & Management."
My Cancer Genome: "ROS1 in Non-Small Cell Lung Cancer (NSCLC)."
Radiological Society of North America: "Lung Cancer Treatment."
UpToDate: "Patient Education: Non-Small Cell Lung Cancer Treatment; stage I to III Cancer (Beyond the Basics)," "Patient Education: Non-Small Cell Lung Cancer Treatment; stage IV cancer (Beyond the Basics)," "Patient Education: Small Cell Lung Cancer Treatment (Beyond the Basics)."
FDA: “FDA approves dacomitinib for metastatic non-small cell lung cancer,” “FDA approves lorlatinib for second- or third-line treatment of ALK-positive metastatic NSCLC.”