Chemotherapy

Chemotherapy is a word that describes many different cancer treatments that are given in drug form. Here, chemotherapy is used specifically to describe intravenous drugs that are designed to kill cancer cells.

Chemotherapy has been used for many years to treat lung cancer. Although there has been a lot of excitement in the past 10 years about newer types of treatment like targeted therapies, angiogenesis inhibitors, and immunotherapy, traditional chemotherapy is still an important tool for treating lung cancer. In fact, it may be used in combination with some of these more recent treatments to make them more effective.1 Your doctor will help to select the best treatment based on your medical history and fitness.

How does chemotherapy work?

Healthy normal cells in the body grow and divide in an orderly manner to replace old or damaged cells. Cancer cells have lost that capacity and divide out of control. Chemotherapy drugs work by targeting and killing all rapidly dividing cells in the body. Cancer cells are the primary target, but some normal cells are also affected, which is why chemotherapy causes side effects.2

How is chemotherapy given?

Chemotherapy injectionChemotherapy can be administered in many ways, including orally, intravenously, subcutaneously, and intramuscularly. When given in these ways, it is called systemic chemotherapy because the drugs travel throughout the whole body (system) in the bloodstream to reach cancer cells wherever they are. To treat lung cancer, chemotherapy drugs are usually given intravenously.

When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.2

Chemotherapy may be given one drug at a time or as a combination of different drugs at the same time. Usually chemotherapy is given in cycles. Each cycle consists of a period of treatment of 1 to 3 days, followed by a break before the next treatment cycle so that a patient can rest and allow the body time to recover. A chemotherapy cycle generally lasts 3 weeks and continues over a period of months.3,4 Sometimes chemotherapies are planned for a specific number of cycles. In other situations, chemotherapy is planned to be continual—given on an ongoing basis as long as it is tolerated.

The number of treatments within a cycle, the length of a cycle, and the number of cycles to be given may vary based on the type and stage of lung cancer and the drug(s) being given. It is always a good idea for patients to confirm with their doctor that they understand their overall treatment plan, including:

  • What drugs are being used
  • The drug schedule
  • The length of a cycle
  • How many cycles are planned

When is chemotherapy given for lung cancer?

Depending on the type and stage of lung cancer, chemotherapy may be the only treatment used or it may be used along with other types of treatment.

In small cell lung cancer, chemotherapy is usually the main treatment for two reasons:

  1. Small cell lung cancer responds very well to chemotherapy.
  2. Small cell lung cancer can spread beyond the lungs even at an early stage. Chemotherapy is the best option to treat cancer that has spread, so it is given in almost all small cell lung cancer cases, even if there is no sign of spread on CT scans.

In non-small cell lung cancer (NSCLC), chemotherapy may be used as the main treatment, but it is also frequently given along with other treatments. When given along with other treatments, it is referred to as adjuvant, neoadjuvant, or concurrent.1,4

  • Adjuvant chemotherapy: After surgery there may still be some microscopic cancer cells left behind that cannot be seen on regular scans. When chemotherapy is given to kill those unseen cancer cells, it’s called adjuvant chemotherapy.  
  • Neoadjuvant chemotherapy: Chemotherapy can be given before surgery to shrink the cancer and make it easier to remove with surgery. This is called neoadjuvant chemotherapy. Sometimes neoadjuvant chemotherapy is given along with radiation therapy.
  • Concurrent chemotherapy: When chemotherapy is given at the same time as radiation therapy, this is called concurrent chemotherapy, or sometimes concurrent chemoradiotherapy. Concurrent treatment may be given as the only planned therapy or it may be given in the neoadjuvant setting, before a planned surgery.

People with late-stage (stage IV) lung cancer whose cancer shrank or stopped growing after initial chemotherapy treatment may be offered maintenance therapy. The goal of maintenance therapy is to help keep the cancer from growing again. Generally, a person is kept on maintenance therapy as long as the cancer stays controlled.

Maintenance therapy schedule for lung cancer

Another approach after induction/initial therapy is to stop treatment after the initial treatment. Then the cancer is carefully monitored by the oncologist, and second-line treatment is given if there is disease progression.5

What are the goals of chemotherapy in lung cancer?

The goals of chemotherapy depend on the type of cancer being treated, the stage of the cancer, and whether other types of therapy will also be given. Some possible goals of chemotherapy include:

  • To eliminate all of the cancer cells and to prevent recurrence
  • To decrease the size of tumors for easier and safer removal by surgery
  • To control the lung cancer by stopping it from growing and spreading
  • To help make other cancer-killing treatments, such as radiation therapy, more effective
  • To relieve symptoms caused by the cancer and to slow its growth when the lung cancer is at an advanced stage. This is called palliative care or palliation.1,2,4

Why are there side effects from chemotherapy drugs?

Chemotherapy drugs kill rapidly dividing cells and cannot tell the difference between healthy normal cells that divide fast and cancer cells. Healthy cells that divide rapidly include hair cells, blood cells (red blood cells, platelets, and white blood cells), and the cells lining the mouth and intestines. When chemotherapy kills these normal cells, it can cause side effects. However, normal cells can repair the damage or be replaced by other healthy cells, which is why side effects are usually temporary.1,2

What are some common side effects of chemotherapy?

Note:  Each drug has a different set of most common side effects. It’s important to remember that just because a side effect is possible doesn’t mean that it will happen to you.

  • Fatigue: Secondary to the number of red blood cells being below normal (anemia) or sometimes directly related to the chemotherapy drug, without anemia
  • Easy bruising or bleeding: Due to a low number of blood platelets (thrombocytopenia )
  • Increased risk of infection: Due to a low number of white blood cells (neutropenia)
  • Hair loss
  • Mouth and throat sores
  • Nausea, vomiting
  • Loss of appetite or changes in taste buds
  • Diarrhea, constipation
  • Peripheral neuropathy: Pain, burning or tingling sensations, sensitivity to cold or heat, or weakness mainly in the hands and feet

Even when the effects of chemotherapy are monitored closely, some long-term effects can occur, sometimes years after therapy is completed. For that reason, it is important that every patient who receives chemotherapy be followed up throughout his or her life by a physician who is aware of the potential effects of treatment.2,4

How can the side effects of chemotherapy be managed?

When I was told I had cancer, one of the first images that popped into my head was of me being bald and frail from chemo. So one of the biggest lessons for me has been that the chemo with which I was treated doesn't cause the side effects I had come to associate with cancer treatment.

—C.K., survivor with NSCLC

It is important for patients to discuss each chemotherapy drug with their oncologist to be prepared for potential side effects and to understand what can be done to treat them. The oncologist can often prescribe drugs or make recommendations about other things that can be done to help relieve and/or prevent many of these side effects. One key tip is to communicate with the doctor if and when new side effects begin, as treating them early on is often more effective than trying to treat them once they have already become severe. Although most side effects go away when treatment is over, some can last a long time. Sometimes, the doses of the chemotherapy drugs may need to be lowered or treatment may need to be delayed to prevent the side effects from getting worse. Fortunately, newer chemotherapy regimens cause fewer side effects and have been found to be as effective as older treatments.3

  • Fatigue: If a patient becomes anemic from chemotherapy, a blood transfusion is sometimes given to increase the number of red blood cells in the blood.
  • Nausea, vomiting: There are multiple medications available to prevent and treat nausea and vomiting. If one anti-nausea medication doesn’t work, the oncologist can switch to a different one or prescribe an additional one. Techniques such as distraction, relaxation, and positive imagery can help change the expectation and fear of nausea and vomiting.
  • Loss of appetite: Appetite stimulants and nutritional supplements can be given to improve appetite and reduce weight loss.
  • Diarrhea, constipation: Anti-diarrheal medications, stool softeners, and laxatives can be prescribed as needed.
  • Peripheral neuropathy: Sometimes physical therapy and complementary therapies, such as massage and acupuncture, can help. The most common medications to treat neuropathic pain are anticonvulsants and antidepressants. Over-the-counter pain medications may be recommended for mild pain, or prescription non-steroidal anti-inflammatory drugs or analgesics may be prescribed for severe pain.3

What are the most common chemotherapy drugs used to treat non-small cell lung cancer (NSCLC)?

Below is a listing of the most commonly used chemotherapies for NSCLC.4

Generic Name Brand Name (in US) [all registered trademarks]
Cisplatin Platinol-AQ
Carboplatin Paraplatin
Pemetrexed Alimta
Paclitaxel Taxol, Onxol
Paclitaxel (albumin-bound) Abraxane
Docetaxel Taxotere
Gemcitabine Gemzar
Vinorelbine Navelbine
Irinotecan Camptosar
Etoposide Etopophos
Vinblastine Velban
Cetuximab Erbitux

What are the most common chemotherapy drugs used to treat small cell lung cancer (SCLC)?

Combination chemotherapy is usually the main treatment for patients with small cell lung cancer. The most commonly used chemotherapies in SCLC are3,4:

Generic Name Brand Name (in US)
Cisplatin Platinol-AQ
Carboplatin Paraplatin
Irinotecan Camptosar
Etoposide Etopophos
Paclitaxel (albumin-bound) Abraxane
Docetaxel Taxotere

What clinical research study (clinical trial) options are available?

If you are considering participating in a clinical trial, start by asking your doctor whether there is one for which you might qualify in your area. In addition, here are several resources to help you find one that may be a good match for you:

Learn more about clinical trials here.

Questions to ask your health care team about chemotherapy

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  1. Why do I need chemotherapy?
  2. What are the advantages and disadvantages of chemotherapy for me?
  3. How successful is chemotherapy for my type of cancer?
  4. Are there any other treatments I can have instead?
  5. How much does treatment cost?
  6. What drugs will I be receiving? How will they be given?
  7. How often will I receive this treatment? How long will I have treatment?
  8. Where will I have the chemotherapy? Can I have it close to where I live?
  9. What are the possible side effects of this treatment and what can I do to control them?
  10. Are there any complementary therapies that will help?
  11. How will I know if the treatment is working?
  12. Will chemotherapy affect my sex life and fertility?
  13. After treatment has finished, will I need checkups?
  14. Who should I contact for information or if I have a problem during treatment? Who is my after-hours contact?

Updated February 24, 2016.


References

  1. Kris MG, Hellman MD, Chaft JE. Chemotherapy for Lung Cancers: Here to  Stay. 2014 ASCO Educational Book website. http://meetinglibrary.asco.org/content/11400375-144. Accessed February 24, 2016.
  2. Non-small Cell Lung Cancer Treatment Option Overview. National Cancer Institute website. http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/Patient/page4#Keypoint23. Accessed February 24, 2016.
  3. Lung Cancer – Non-Small Cell: Treatment Options. American Society of Clinical Oncology website. http://www.cancer.net/cancer-types/lung-cancer/treatment-options. Approved August 20, 2015. Accessed February 24, 2016.
  4. Ramalingham SS, Pillai RN, Reinmuth N, Reck M. Section 44: First-Line Systemic Therapy Options for Non-small Cell Lung Cancer. In: Pass HI, Ball D, Scagliotti GV, eds. The IASCL Multidisciplinary Approach to Thoracic Oncology. Aurora, CO: IASLC Press; 2014:583-605.
  5. Reck M, Heigener DF, Mok T. Management of non-small-cell lung cancer: recent developments. The Lancet. August 24: 2013:382:709-713.

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