When You Can't Get Surgery for Metastatic NSCLC

If you have "metastatic" non-small-cell lung cancer (NSCLC), it means the disease has spread to other parts of your body.

You may hear your doctor call your cancer "unresectable." That means surgery is no longer a treatment option for your cancer.

Even though you can't have surgery for your lung cancer, other treatments are available to you. Chemotherapy, radiation, targeted therapy, and immunotherapy can slow your cancer and ease your symptoms. Your health and your test results will help you and your doctor figure out the best choice.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from dividing. You take these medicines by mouth or through an IV into a vein.

Chemo comes in four to six cycles. You take the drug for a few days per cycle. Then you take a few days off to give your body time to rest. Each chemo cycle is 3 or 4 weeks long.

You may get treatment for even longer to keep your cancer under control. This is called maintenance therapy.

Several chemotherapy drugs treat NSCLC. Doctors often suggest you take a combination of two medications. Sometimes you'll get chemo together with other treatments like targeted therapy or radiation.

Because chemo also kills some healthy cells, it can cause side effects like:

  • Hair loss
  • Appetite loss
  • Nausea and vomiting
  • Mouth sores
  • Diarrhea or constipation
  • Higher chance of infections
  • Easy bruising or bleeding
  • Tiredness

These side effects usually go away after you stop treatment. While you're on chemo, your doctor can help you manage them.

Radiation Therapy

This treatment uses high-energy particles like X-rays to kill or damage cancer cells. You may get radiation together with chemotherapy or other treatments.

You usually get radiation from a machine that aims the beams at your cancer from outside your body. Less often, radiation pellets go into your lungs to treat your cancer from the inside.

Radiation treatments take only a few minutes. You get them 5 days a week for 5 to 7 weeks.

You might get side effects such as:

  • Tiredness
  • Nausea and vomiting
  • Appetite loss
  • Weight loss
  • Redness, blisters, and peeling in the treated area
  • Hair loss

Having radiation with chemo can add to the side effects. These problems should go away when your treatment ends.

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Targeted Therapy

These drugs target proteins and other substances that help cancer cells grow. They don't harm healthy cells as much as chemo and radiation do.

Your doctor will test you to see if you have one of these gene changes before giving you targeted drugs:

EGFR . If you have this gene change, you'll get a drug to block it, such as:

  • Afatinib (Gilotrif)
  • Dacomitinib (Vizimpro)
  • Erlotinib (Tarceva)
  • Gefitinib (Iressa)
  • Osimertinib (Tagrisso)

The most common side effects are skin rashes, diarrhea, mouth sores, and appetite loss. Usually these side effects are mild.

ALK. Medications for this gene change include:

  • Alectinib (Alecensa)
  • Brigatinib (Alunbrig)
  • Ceritinib (Zykadia)
  • Crizotinib (Xalkori)

These medicines help shrink tumors when chemo stops working. Ceritinib and crizotinib also work in people with a gene change called ROS1.

Side effects include nausea, vomiting, diarrhea, constipation, tiredness, and vision changes.

BRAF. Dabrafenib (Tafinlar) and trametinib (Mekinist) target changes to the BRAF protein. They work in different ways, and you may get them together. They can cause itching, rash, headache, and other side effects.

Other targeted therapies work on different proteins, like MEK, KRAS, or NTRK. Studies are looking for even more gene changes.

VEGF. Bevacizumab (Avastin) and ramucirumab (Cyramza) are drugs that block the VEGF protein, which helps new blood vessels grow. Tumors need blood vessels to survive. Side effects of these drugs include high blood pressure, tiredness, and bleeding.

Immunotherapy

Immunotherapy is a treatment that uses your immune system -- your body's defense against germs and other "invaders" -- to help fight your cancer. You may try one of these drugs if you can't get targeted therapy because you don't have a gene change.

Your immune system has checkpoints that stop it from attacking your own cells. Cancer cells sometimes hide behind these checkpoints so your immune system can't find them.

Nivolumab (Opdivo) and pembrolizumab (Keytruda) are immunotherapy drugs called "checkpoint inhibitors." They target a protein called PD-1 to take the brakes off immune cells so they can attack the cancer. Atezolizumab (Tecentriq) and durvalumab (Imfinzi) target a similar protein, PD-L1.

Typical side effects of these drugs include tiredness, cough, nausea, itching, and rash.

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Palliative Therapy

Palliative care won't slow your cancer. But along with your other treatments, it can relieve symptoms like pain and shortness of breath to help you feel better.

Palliative treatments include:

  • Medicines to relieve pain and cough
  • Oxygen to help you breathe
  • A procedure to drain fluid from around your lungs or heart
  • Laser treatment to open a blocked airway
  • Massage and other treatments to help you relax

Clinical Trials

If your cancer comes back or other treatments haven't worked, you might want to try a clinical trial. These studies test out new lung cancer treatments. It's a way for you to try a drug that isn't available to everyone. The new treatment may work better than one you've tried.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on December 30, 2019

Sources

SOURCES:

American Cancer Society: "Chemotherapy for Non-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," "Targeted Therapy for Non-Small Cell Lung Cancer," "Treatment Choices for Non-Small Cell Lung Cancer, By Stage."

American Lung Association: "Supportive (Palliative) Care for Lung Cancer."

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