Chemotherapy for Non-Small Cell Lung Cancer (NSCLC)
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Chemotherapy is one of the more common treatments for lung cancer, which includes non-small cell lung cancer (NSCLC). This article will explore how chemotherapy is being used to treat NSCLC. This information might be especially useful for individuals beginning chemotherapy treatment.
Chemotherapy is a type of systemic treatment that treats cancer cells anywhere in the body. It kills fast-growing cells by targeting dividing cells at different growth stages. For this reason, it is toxic to both cancer and healthy cells.
When is chemotherapy used to treat NSCLC?
To treat NSCLC, doctors prescribe chemotherapy
- In combination with other therapy (radiation or immunotherapy)
- When treating by cell types without driver mutations
- Based on performance status
- As adjuvant therapy following radiation therapy and surgery
- As neoadjuvant therapy in combination with immunotherapy or radiation therapy – given before surgery to shrink the tumor and make surgery easier.
- As maintenance therapy
When treating NSCLC with chemotherapy, doctors categorize it according to cell types rather than driver mutations. Older or frail patients with a poor performance score (performance score >2) may not benefit from chemotherapy, while experiencing the toxic effects of treatments Therefore, chemotherapy is recommended for individuals with a performance status ranging from 0-2.
Sometimes, doctors may start patients on systemic therapy while waiting for molecular test results. If a driver mutation is subsequently found, the initial therapy may be stopped and continued with the appropriate targeted drug. This approach ensures patients receive the most appropriate and effective care tailored to their conditions.
List of common chemotherapeutic drugs used in NSCLC treatment
Based on performance score (PS) and cell types, the National Comprehensive Cancer Network (NCCN) recommends first-line chemotherapy for
Adenocarcinoma, large cell, and other NSCLC subtypes
Chemotherapy with immunotherapy | PS 0 or 1 | PS 2 |
|---|---|---|
(Carboplatin or cisplatin), pemetrexed | ● | |
Carboplatin, paclitaxel | ● | |
Carboplatin, albumin-bound paclitaxel | ● | |
(Carboplatin or cisplatin), pemetrexed | ● |
Chemotherapy without immunotherapy | PS 0 or 1 | PS 2 |
|---|---|---|
Carboplatin, paclitaxel | ● | |
(Carboplatin or cisplatin), pemetrexed | ● | |
Cisplatin and another chemotherapy | ● | |
Carboplatin and other chemotherapy | ● | |
Gemcitabine and (docetaxel or vinorelbine) | ● | ● |
Single-agent chemotherapy | ● |
Squamous cell carcinoma
Chemotherapy with immunotherapy | PS 0 or 1 | PS 2 |
|---|---|---|
Carboplatin, paclitaxel (preferred) | ● | |
Carboplatin, albumin-bound paclitaxel (preferred) | ● | |
Carboplatin, paclitaxel | ● |
Chemotherapy without immunotherapy | PS 0 or 1 | PS 2 |
|---|---|---|
Cisplatin and another chemotherapy | ● | |
Carboplatin and other chemotherapy | ● | ● |
Gemcitabine and (docetaxel or vinorelbine) | ● | ● |
Single-agent chemotherapy | ● |
The brand names for chemotherapeutic agents:
- Platinol® (cisplatin)
- Paraplatin® (carboplatin)
- Taxotere® (docetaxel)
- VePesid® or Etopophos® (etoposide)
- Gemzar® (gemcitabine)
- Taxol® (paclitaxel)
- Abraxane® (albumin-bound paclitaxel)
- Alimta® (pemetrexed)
- Navelbine® (vinorelbine)
Single drug or in combination?
Chemotherapeutic agents are normally given with other drugs (radiation or immunotherapy) during first-line treatment. Doctors may order single-agent chemotherapy
- When the performance status of a patient is too poor (the patient cannot tolerate the side effects)
- As maintenance therapy
Drugs used as single-agent chemotherapy:
- Albumin-bound paclitaxel
- Docetaxel
- Gemcitabine
- Paclitaxel
- Pemetrexed (only for non-squamous cell carcinoma)
Chemotherapy in combination with immunotherapy
Cancer cells can sometimes evade killing by the immune system. Chemotherapeutic agents break down the cancer cells so the immune checkpoint inhibitors and the immune system can target them easily.
Common immune checkpoint inhibitors used in chemoimmunotherapy of NSCLC:
- Keytruda® (pembrolizumab)
- Tecentriq® (atezolizumab)
- Opdivo® (nivolumab)
- Yervoy® (ipilimumab)
- LIBTAYO® (cemiplimab)
Read more: Immunotherapy for Lung Cancer
Chemotherapy in combination with radiotherapy
Chemoradiotherapy is used to manage NSCLC:
- In early-stage patients who are not surgical candidates
- As concurrent therapy for certain NSCLC subtypes
Chemoradiotherapy is normally administered with platinum-based chemotherapy plus full-dose radiotherapy.
Read more: Radiation Therapy for Lung Cancer
Chemotherapy in combination with bevacizumab
Avastin® (bevacizumab) is an anti-VEGF monoclonal antibody. It targets the VEGF protein on the cell surface. VEGF mediates signaling pathways involved in angiogenesis (formation of new blood vessels), tumor growth and metastasis (cancer spreading).
Compared to chemotherapy alone, the addition of bevacizumab to chemotherapy has been shown to offer
- higher response rate
- longer progression-free survival
- improved overall survival
Maintenance therapy
If the response from initial chemotherapy is good and stable, patients may drop other drugs and stay with one medicine from the initial chemotherapy. This is called maintenance therapy.
Maintenance therapy for NSCLC patients without driver mutation usually include
- Single-agent chemotherapy (see above)
- Bevacizumab
- Pembrolizumab
Patients on maintenance therapy must be routinely monitored for cancer progression or relapse.
Related: Maintenance Therapy in Lung Cancer: Who, What, Why, When, How
There are various therapies available to treat NSCLC. While the treatment journey may not always be straightforward, do not lose hope. Changes may arise during the treatment process, but trust in the experienced cancer care team to navigate the path ahead of you. While it is completely understandable to feel scared, rely on them to figure out the next best steps.
