Once non-small-cell lung cancer (NSCLC) spreads far and wide, treating it is kind of a balancing act. A cure isn't likely, but you can slow it down. So you aim to relieve your symptoms and improve your quality of life with as few side effects as possible.
Newer therapies can help you do just that. And there are a lot more options today than just a few years ago. The number of tumors, where they are, and your overall health all come in to play when deciding what to do.
Your doctor will start with a few tests to learn more about your NSCLC and help guide you to the best treatment.
When Targeted Therapy Works Best
Cancer comes about when a gene change causes a cell to grow and divide out of control. But you have so many genes, it's often hard to know which ones to blame.
With NSCLC though, doctors have tracked down a few of the culprits. When you have one of these known changes, you get targeted therapy. That means you take drugs that attack cancer cells in specific ways based on gene differences.
Your doctor will do a test to look for:
ALK gene change. If you have it, you'll get a drug that helps block it, such as:
- Alectinib (Alecensa)
- Brigatinib (Alunbrig)
- Ceritinib (Zykadia)
- Crizotinib (Xalkori)
- Lorlatinib (Lorbrena)
EFGR gene change. You get a different set of drugs for this one, such as:
- afatinib (Gilotrif)
- dacomitinib (Vizimpro)
- erlotinib (Tarceva), gefitinib (Iressa)
- osimertinib (Tagrisso).
They slow down how fast tumors grow and spread. Side effects include skin rash and diarrhea.
BRAF gene change. Two of the main drugs used for this one are dabrafenib (Tafinlar) and trametinib (Mekinist). They work in different ways, but both can be effective. They may cause itching, hair loss, and other issues.
NTRK gene defect: there are three drugs to use against a defect in the neurotrtrophic tyrosine receptor kinese (NTRK).
They work by blocking the enzyme to help keep the tumor from growing. Entrectinib (Rozlytrek) also works on ROS1-positive metastatic NSCLC
Other gene changes. There's a growing list of gene defects that can cause NSCLC, but not all of them have targeted drugs. That's one reason to look into clinical trials, where researchers test new medicines.
When Immunotherapy Makes the Most Sense
When you don't have a specific gene change, your doctor will check tumor cells for their level of a protein called PD-L1. If it's high, immunotherapy is often the best place to start. It uses your immune system -- your body's defense against germs -- to attack cancer cells.
There are several chemo drugs used for NSCLC. For the best results, your doctor gives you two at a time. If your body isn't strong enough for two, even one can be helpful. You usually get four to six cycles of chemo, each taking about 3 weeks.
Once you're finished with treatment, you might keep taking what's called a maintenance drug. This is often another chemo medicine. Some research shows that this can slow the cancer down and help you live longer.
Your doctor may also add in some other drugs along with your chemo meds:
- For non-squamous NSCLC, you might also take pembrolizumab (Keytruda), the immunotherapy drug. Or you might get bevacizumab (Avastin), another targeted drug. If so, you may keep taking one of these as your maintenance drug.
- For squamous NSCLC, your doctor might suggest the targeted therapy drug necitumumab (Portrazza).
If it's in just one other place, like your brain or adrenal gland, you might have surgery to remove the tumor.
Sometimes, the first therapy you try doesn't work as well as you'd hope. But you still have options.
If you started with immunotherapy, your doctor may suggest chemo. If you started with one set of chemo drugs, you might try another or add in targeted therapy. It depends on your health, how far the cancer has spread, and what you want from treatment.