Chemotherapy for Non-Small Cell Lung Cancer

Chemotherapy (chemo) is treatment with anti-cancer drugs that may be injected into a vein or taken by mouth.

When is chemotherapy used?

Chemotherapy travels through the bloodstream and reaches most parts of the body. Not all people with non-small cell lung cancer (NSCLC) will need chemo, but depending on the cancer’s stage and other factors, chemo may be recommended in different situations:

• Before surgery (neoadjuvant chemotherapy): Neoadjuvant chemo may be used (sometimes with radiation therapy) to try to shrink a tumor to make it easier to remove it with less extensive surgery.
• After surgery (adjuvant chemotherapy): Adjuvant chemo may be used (sometimes with radiation therapy) to try to kill any cancer cells that might have been left behind or have spread but can’t be seen on imaging tests.
• For locally advanced NSCLC: Sometimes, chemo along with radiation therapy is given as the main treatment for more advanced cancers that have grown into nearby structures if surgery is not an option or for people who aren’t healthy enough for surgery.
• For metastatic (stage IV) NSCLC: Chemo may be given for lung cancer that has spread to areas outside the lung, such as the bones, liver, or adrenal gland.

Chemo is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemo.

Chemotherapy drugs used to treat NSCLC

The chemo drugs most often used for NSCLC include:

• Cisplatin
• Carboplatin
• Paclitaxel (Taxol)
• Albumin-bound paclitaxel (nab-paclitaxel, Abraxane)
• Docetaxel (Taxotere)
• Gemcitabine (Gemzar)
• Vinorelbine (Navelbine)
• Etoposide (VP-16)
• Pemetrexed (Alimta)

Combinations of 2 chemo drugs are often used to treat early-stage lung cancer. If a combination is used, it often includes cisplatin or carboplatin plus one other drug.

Advanced lung cancer though may be treated with a single chemo drug especially in people who might not tolerate combination chemotherapy well, such as those in poor overall health or who are elderly.

For some people, a targeted therapy drug or an immunotherapy drug may be given alone or with chemotherapy. For more on this, see Treatment Choices for Non-Small Cell Lung Cancer, by Stage.

How is chemotherapy given?

Chemo drugs for lung cancer are typically given into a vein (IV), either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctor’s office, chemotherapy clinic, or in a hospital setting.

Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. They are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.

Many different kinds of CVCs are available. The most common types are the port and the PICC (peripherally inserted central catheter) line.

A port is a small quarter-sized device that is placed under the skin in your upper chest. A small tube connects the port to a large vein that goes into the heart, called the superior vena cava.

A PICC line is a small tube that is placed in the upper arm; that tube threads through the vein until reaches the superior vena cava.

Chemo is given in cycles. Each cycle includes the period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 3 or 4 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

Adjuvant and neoadjuvant chemo is often given for 3 to 4 months, depending on the drugs used. The length of treatment for advanced lung cancer is based on how well it is working and what side effects you have.

For advanced cancers, the initial chemo combination is often given for 4 to 6 cycles. Some doctors now recommend giving treatment beyond this with a single chemo or targeted drug, in people who have responded well to their initial chemotherapy or have had no worsening of their cancer. Continuing this treatment, known as maintenance therapy, seems to help keep the cancer in check and help some people live longer.

If the initial chemo treatment for advanced lung cancer is no longer working, the doctor may recommend second-line treatment with chemo, targeted therapy, immunotherapy, or a clinical trial.

Possible side effects of chemo for NSCLC

Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long they are taken. Some common side effects include:

• Hair loss
• Mouth sores
• Loss of appetite and weight loss
• Nausea and vomiting
• Diarrhea or constipation

Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:

• Increased chance of infections (from low white blood cell counts)
• Easy bruising or bleeding (from low blood platelet counts)
• Fatigue (from low red blood cell counts)

These side effects usually go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Some drugs can have specific side effects. For example, drugs such as cisplatin, vinorelbine, docetaxel, or paclitaxel can cause nerve damage (peripheral neuropathy). This can sometimes lead to symptoms (mainly in the hands and feet), such as pain, burning or tingling sensations, sensitivity to cold, or weakness. In most people, this goes away or gets better once treatment is stopped, but it might last a long time in others.

Be sure to report any side effects you notice during chemo to your cancer care team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to keep the side effects from getting worse.