Treating Lung Cancer - Non-Small Cell

Targeted Therapy

As researchers have learned more about the gene changes in cells that cause cancer, they have been able to develop newer drugs that specifically target these changes. These targeted drugs work differently than standard chemotherapy drugs. They often have different (and less severe) side effects. At this time, they are most often used either along with chemotherapy or in cases where chemotherapy is no longer working.

Drugs that target tumor blood vessel growth (angiogenesis)

For tumors to grow, they must form new blood vessels to keep them nourished. This process is called angiogenesis. Some newer targeted drugs block this new vessel growth.

Bevacizumab (Avastin) is a type of drug known as a monoclonal antibody (a manmade version of a specific immune system protein). It targets vascular endothelial growth factor (VEGF), a protein that helps new blood vessels to form. This drug has been shown to prolong survival of patients with advanced lung cancer when it is added to standard chemotherapy regimens as part of first-line treatment.

Bevacizumab is given by infusion into a vein every 2 to 3 weeks.

The possible side effects of this drug are different from those of chemotherapy drugs. Some of these effects can be serious. It can cause bleeding, which limits its use to some extent. It is not used in patients who are coughing up blood, who have cancer that has spread to the brain, or who are on "blood thinners" such as aspirin or warfarin (Coumadin). Most current guidelines do not recommend using bevacizumab in patients with squamous cell cancer, because it may lead to serious bleeding from this type of lung cancer. However, studies are under way to see if bevacizumab is safe as long as the squamous cell cancer is not located near large blood vessels in the center of the chest cavity.

Other possible effects include high blood pressure, loss of appetite, delayed wound healing, and an increased risk of blood clots.

Drugs that target EGFR

Epidermal growth factor receptor (EGFR) is a protein found on the surface of cells. It normally receives signals telling the cells to grow and divide. Some lung cancer cells have too many copies of EGFR, which help them grow faster.

Erlotinib (Tarceva): Erlotinib is a drug that blocks EGFR from signaling the cell to grow. It has been shown to help keep some lung tumors under control, especially in women and in people who never smoked. It is most often used for advanced lung cancers if initial treatment with chemotherapy is no longer working.

This drug is taken daily as a pill. The most common side effects of erlotinib include an acne-like rash on the face and chest, diarrhea, loss of appetite, and feeling tired.

Cetuximab (Erbitux): Cetuximab is a monoclonal antibody that targets EGFR. For patients with advanced lung cancer, some doctors may add it to standard chemotherapy as part of first-line treatment.

Cetuximab is given by IV infusion, usually once a week. A rare but serious side effect of cetuximab is an allergic reaction during the first infusion, which could cause problems with breathing and low blood pressure. You may be given medicine before treatment to help prevent this. Other, less serious side effects may include an acne-like rash, headache, tiredness, fever, and diarrhea.