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Chemotherapy and Other Drugs for Lung Cancer

Chemotherapy uses drugs to kill cancer cells. The drugs enter the bloodstream and travel through the body in order to kill cancer cells. The side effects come from the fact that it destroys normal cells as well as cancer cells. Chemotherapy may be given either alone or along with radiation therapy. When given alone, it is given in a higher dose designed to kill off cancer cells. When given along with radiation therapy, it is delivered at a lower dose and is designed to make the cancer more sensitive to the radiation.

Treatment Cycles

Chemotherapy is usually given by vein, but some forms can be given by mouth. Your treatment team will tell you how many cycles or courses of chemotherapy are best for you. Usually there are between 4-6 cycles of chemotherapy given when the chemotherapy is delivered on its own, and up to 10 cycles of chemotherapy when the drugs are given along with radiation therapy. The side effects and amount of time required in the doctor’s office depend on the type of chemotherapy you receive, as well as how many cycles you get and how often.

Types of Chemotherapy Drugs

There are a number of chemotherapy drugs that are available. Some examples include:
  • Cisplatin (Platinol-AQ, Platinol)
  • Etoposide (Toposar, VePesid)
  • Bevacizumab (Avastin)
  • Carboplatin (Paraplatin, Paraplat)
  • Paclitaxel (Taxol)
  • Docetaxel (Taxotere)
  • Vinorelbine (Navelbine)
Most treatment regimens will combine two or more of these drugs. The types, dosages, and duration of treatment will depend on the stage and type of your tumor and how well it responds to treatment.

Side Effects

While undergoing chemotherapy, most patients suffer from:
  • Fatigue and weakness
  • Loss of appetite
  • Nausea and vomiting
  • Hair loss
  • Fuzziness in thinking, memory problems
Other side effects include:
  • Risk of infection
  • Skin irritation, cracked nails
  • Rash
  • Allergic reactions
  • Mouth sores
  • Diarrhea
  • Constipation
  • Tendency to bleed and bruise easily
  • Fluid retention
  • Bladder problems
  • Numbness in limbs
  • Infertility
  • Fever or chills
  • Low blood cell counts (eg, anemia)
To manage other side effects, you may need to make diet and lifestyle changes and take medicine. For example, your doctor may recommend that you eat several small meals throughout the day and avoid alcohol. Light exercise (eg, walking for 30 minutes) may help to fight fatigue.
Some of these side effects go away soon after chemotherapy has ended, while others linger after treatment.

When to Call Your Doctor

Contact your doctor if you develop:
  • Signs of infection, including fever (100.3°F [37.9°C]) and chills
  • Nosebleeds
  • Sores in your mouth or throat
  • Black and blue marks on your skin
  • Nausea, vomiting, loose or runny bowel movements
  • Pain that you cannot control with the medicine you have been given
  • Cough, shortness of breath, or chest pain
  • Joint pain, fatigue, stiffness, rash, or other new symptoms
  • Tingling in your fingers, toes or ringing in your ears
  • Weight gain or loss of 10 pounds (4.5 kilograms) or more

Newer Treatment Options

Targeted Therapy
Epidermal growth factor receptors (EGFR) play a role in the development of cells, including cancer cells. Some people who have lung cancer also have a mutation that affects EGFR. Because of this, medicines, like cetuximab, have been created to target the action of this receptor. Doctors can test a tissue sample or do blood tests to find out if someone has this mutation. If the result is positive, then treatment with this type of targeted therapy may help the person live longer.
There is also a drug called crizotinib that targets a gene mutation on the anaplastic lymphoma kinase (ALK) gene. This mutation has been linked to adenocarcinoma, a common kind of lung cancer that affects both smokers and non-smokers. Crizotinib may be able to stop cancer from growing and shrink tumors.
Other targeted therapies that are being researched include:
  • Sunitinib
  • Vemurafenib
These drugs are designed to target certain molecules in the cancer cells. By interfering with these molecules, the ability of the cancer to grow and spread is blocked.
Immunotherapy
Immunotherapy involves using medicines or substances made by the body to increase or restore the body's natural defenses against cancer. Monoclonal antibodies are an example of immunotherapy. These antibodies are designed to attack certain proteins in the cancer cells, which helps the immune system fight cancer.
Researchers continue to study new treatments that may be able to stop cancer and prolong life.

References

Chemotherapy (non-small cell). American Cancer Society website. Available at: http://www.cancer.org/Cancer/LungCancer-Non-SmallCell/DetailedGuide/non-small-cell-lung-cancer-treating-chemotherapy. Updated February 17, 2012. Accessed October 1, 2012.

Crizotinib. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/druginfo/crizotinib. Accessed October 1, 2012.

Crizotinib continues to show promise for some lung tumors, faces challenge of drug resistance. National Cancer Institute website. Available at: http://www.cancer.gov/clinicaltrials/results/summary/2010/crizotinib-lung1110. Accessed October 1, 2012.

Lung cancer 101. Lung Cancer.org website. Available at: http://www.lungcancer.org/reading/treatment/types.php#targeted. Accessed October 1, 2012.

Monoclonal antibodies. American Cancer Society website. Available at: http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/Immunotherapy/immunotherapy-monoclonal-antibodies. Updated May 9, 2012. Accessed October 1, 2012.

Targeted cancer therapies. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/targeted. Accessed October 1, 2012.

What is immunotherapy? American Cancer Society website. Available at: http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/Immunotherapy/immunotherapy-types-of-immunotherapy. Updated May 9, 2012. Accessed October 1, 2012.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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