Day 9 – CHEMOTHERAPY FOR LUNG CANCER
Chemotherapy (or simply “chemo”) remains the mainstay of treatment for all subtypes of lung cancer. However, given recent and ongoing advances in immunotherapy and targeted therapy, many researchers feel that in just a few years this won’t necessarily be the case, especially for certain kinds of NSCLC. Nevertheless, at the moment nearly everyone who is treated for lung cancer will be treated with some type of chemotherapy at some point.
Chemo can be used in a number of different contexts:
- Before surgery (sometimes along with radiation therapy) to try to shrink a tumor.
- After surgery (sometimes along with radiation therapy) to try to kill any residual cancer cells not removed during surgery.
- Along with radiation therapy (concurrent therapy) when the tumor can’t be resected by surgery because the cancer has grown into nearby structures
- As the main treatment (sometimes along with radiation therapy) for more advanced cancers or for some people who aren’t healthy enough for surgery.
Chemo works by targeting fast-dividing cells in the body for destruction. While this includes “bad” cancer cells, it also includes other “good” cells like hair, nails, digestive track and bone marrow. This causes hair loss, nail breakage, nausea, digestive problems, weak immune systems and a variety of other side-effects. For precisely this reason, patients and family members typically have a lot of anxiety about chemo, with many wondering if this treatment is worse than the disease.
Chemo affects different people very differently, and advances in concurrent treatments to manage side-effects and dosing means that it need not be a grueling process. Indeed, some people breeze through chemo with few if any side effects and are able to maintain a normal level of activity, while others do indeed struggle and require medical attention to treat infections, low counts of white blood cells and other dangerous impacts from chemo. Moreover, certain kinds of chemo can cause a lot of adverse effects in some patients, while these same people have no problems with others.
Though oral administration is sometimes available, chemo is typically delivered intravenously in “cycles” ranging from a single session to multiple sessions per week. Furthermore, chemo is often given as a combination a couple of chemo drugs or a chemo drug plus targeted or immunotherapy. For example, a common cycle for SCLC is three days of chemo a week – often one day with a double agent and two days with a single agent – followed by three weeks of rest in order to allow the bone marrow to replenish blood cells. This cycle is repeated 4-6 times depending on the efficacy and the patient’s tolerance of the drugs.
The first chemo session in a cycle is often preceded by various lab and blood tests as well as a doctor examination. The final session in a cycle is typically followed by the administration of drugs to boost the immune system, which tends to “crash” a week or so after chemo given the damage to bone marrow cells. Neulasta® has become a popular treatment of this kind because it saves a trip to the hospital the day after chemo. Attached to the patient’s arm or abdomen, it automatically delivers an injection of medication to boost the immune system before being removed by the patient. The most common side-effect of Neulasta® is bone pain precisely because it stimulates the bone marrow to produce more blood cells.
Chemo regimens are very different between NSCLC and SCLC, as well as between different subtypes of NSCLC. Sometimes chemo regimens are determined by individual patients’ response to them in terms of side-effects. In both NSCLC and SCLC, a platinum-based regimen, typically carboplatin or cisplatin, remain the most popular options. Cisplatin is generally more effective on debulking large tumors but is somewhat harsher on the body than carboplatin.
For NSCLC here are the available chemo regimens:
- Paclitaxel (Taxol)
- Albumin-bound paclitaxel (nab-paclitaxel, Abraxane)
- Docetaxel (Taxotere)
- Gemcitabine (Gemzar)
- Vinorelbine (Navelbine)
- Irinotecan (Camptosar)
- Etoposide (VP-16)
- Pemetrexed (Alimta)
For SCLC, nearly all SCLC treatment starts with carboplatin or cisplatin plus etoposide or sometimes irinotecan. On rare occasions other drugs are tried if these treatments cannot be tolerated by the patient.