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Chemotherapy is treatment with anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment useful for cancer that has spread (metastasized) to distant organs. Depending on the type and stage of lung cancer, chemotherapy may be given as the main (primary) treatment or as an addition (adjuvant) to surgery or radiation therapy.
Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks, and initial treatment typically involves 4 to 6 cycles. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy.
Most often, initial treatment for advanced lung cancer uses a combination of 2 chemotherapy drugs. Studies have shown that adding a third chemotherapy drug doesn't add much benefit and is likely to cause more side effects. The drugs most frequently used for initial chemotherapy for NSCLC are:
- cisplatin
- carboplatin
- paclitaxel
- docetaxel
- gemcitabine
- vinorelbine
- irinotecan
- etoposide
- vinblastine
- pemetrexed
The most common combinations include either cisplatin or carboplatin plus one other drug, although some studies have found that using combinations with less severe side effects, such as gemcitabine with vinorelbine or paclitaxel, may be just as effective for many patients.
For people whose cancers meet certain criteria, targeted therapy drugs such as bevacizumab (Avastin) or cetuximab (Erbitux) may be added to initial treatment as well (see "Targeted therapies" section).
Single-drug chemotherapy is sometimes used for people who might not tolerate combination chemotherapy well, such as those in poor overall health.
If the initial chemotherapy treatment is no longer working, second-line treatment usually consists of a single drug such as docetaxel or pemetrexed. Another option may be the targeted therapy erlotinib (Tarceva) (see "Targeted therapies" section).
Again, advanced age is no barrier to receiving these drugs as long as the person is in good general health.
Possible side effects
Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.
The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:
- hair loss
- mouth sores
- loss of appetite
- nausea and vomiting
- increased chance of infections (due to low white blood cell counts)
- easy bruising or bleeding (due to low blood platelet counts)
- fatigue (due to low red blood cell counts)
These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting.
Some drugs such as cisplatin, vinorelbine, docetaxel, or paclitaxel can damage nerves. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. (This is called peripheral neuropathy.) In most cases this goes away once treatment is stopped, but it may be long lasting in some people. You should report this, as well as any other side effects or changes you notice while getting chemotherapy, to your medical team so that they can be treated promptly. In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.
For more general information about chemotherapy, please see our separate document, Understanding Chemotherapy: A Guide for Patients and Families.
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