Chemotherapy is one of the main treatments for advanced lung cancer.
But many people reject it because of the rumors on the Internet that “chemotherapy is useless, just a tool for hospitals and doctors to make money. Because of the side effects, chemotherapy can actually speed up the death of patients.” Is that true?
Of course not.
There’s no question that chemotherapy has very high side effects, and from an emotional perspective, it makes patients suffer, and from a scientific perspective, it severely limits its use. So, personally, I’m not a fan of chemotherapy either.
But to say that it is ineffective is pure rumor. Whether or not to use chemotherapy is, frankly, a choice of risk and benefit, and some people are suitable and some are not. As long as people understand the objective effects and risks of chemotherapy, whatever choice they make is the right choice.
Of course, I want such choices to be made by the patients themselves.
My biggest fear is that people who don’t understand chemotherapy at all will give up on this option and go into the arms of a “miracle doctor” and end up with no money.
What is chemotherapy? Where do the side effects come from?
Chemotherapy is a systemic treatment. Chemotherapy drugs are given orally or intravenously into the body and travel throughout the body with the bloodstream, and because of this, it can be used for advanced cancers and is effective for metastatic cancer cells.
There are many different kinds of chemotherapy drugs, but the essential mechanism is to kill the fast-growing cells.
This is why it works and where the side effects come from.
Cancer cells grow fast, so chemotherapy is useful, but unfortunately, there are many normal cells in our body that are also growing fast, such as the hair follicle cells under the scalp, which is why patients on chemotherapy lose all their hair.
Hematopoietic stem cells, which are responsible for making blood and maintaining the immune system, are also killed, so the immune system is compromised in chemotherapy patients. The epithelial cells of the digestive tract are also killed, so the patient has severe diarrhea, no appetite, and so on.
Kill a thousand enemies and damage yourself.
Such severe side effects leave doctors with a constant trade-off, even a compromise, between curing the cancer and keeping the patient essentially alive. That’s why all drug concentrations in chemotherapy must be strictly controlled and cannot be used all the time; they must come one treatment at a time.
If chemotherapy drugs could be used consistently in high doses all the time, like antibiotics, cancer would have been cured long ago; unfortunately, we can’t do that now.
(Image from Station Cool Helo)
What is the efficacy of chemotherapy?
Chemotherapy doesn’t really have a long history, only a few decades. The first chemotherapy drugs appeared in the 1940s, and before it, there were no systematic treatment options for cancer, but only local treatments like surgery and radiation therapy, so patients with advanced cancer that metastasized were almost always left to die.
The advent of chemotherapy has changed the fate of many patients.
For some types of cancer, chemotherapy works very well!
The main factor behind these advances, from 1970 to now, is the use and optimization of chemotherapy, as survival rates have increased from 67% to 98% for testicular cancer, from 12% to 62% for leukemia, and from 40% to about 75% for non-Hodgkin’s lymphoma.
For these cancer types, many patients can live more than 10 years, 20 years, with a clinical cure on chemotherapy alone. The rumors that make chemotherapy drugs out to be useless, money-seeking poisons are clearly relying on people’s unfamiliarity with the reality of the situation, opening their eyes and ignoring the countless lives that have been saved by chemotherapy.
Of course, chemotherapy is not a miracle drug, it is not for everyone, and needs to be analyzed on a case-by-case basis.
How should chemotherapy be used in lung cancer treatment?
Chemotherapy for lung cancer can be divided into two main categories, depending on when it is used and for what purpose.
- Chemotherapy usually plays an adjuvant role if the patient is operable.
- Used before surgery to reduce the size of the tumor, this is called “neoadjuvant therapy.
- Post-surgery is used to kill any cancer cells that may still be in the body, and this is called “adjuvant therapy.
- For patients with advanced cancer or those who cannot have surgery because of poor health, chemotherapy can be the primary treatment (sometimes accompanied by radiation therapy, called synchronized chemoradiotherapy). Overall, although it is difficult to cure advanced lung cancer, chemotherapy can relieve patients’ symptoms and prolong their lives.
Chemotherapy is not for everyone. For example, chemotherapy is generally not recommended for patients in poor health because of significant side effects.
As I mentioned in an earlier article, patients must keep up with their nutrition and not believe in the “starve the cancer out” crap. The patient’s health is poor, the choice of treatment options and quality of life are much worse, and recovery from various treatments is slow.
(Image from Station Cool Helo)
Small cell lung cancer vs non-small cell lung cancer, how are the chemotherapy drugs different?
It’s worth noting that the chemotherapy drugs used for non-small cell lung cancer and small cell lung cancer are a little different.
Small cell lung cancer is usually treated with combination chemotherapy, and the most commonly used combinations are.
- Cisplatin (or carboplatin) in combination with etoposide
- Cisplatin (or carboplatin) in combination with irinotecan
And a wider selection of chemotherapeutic agents for non-small cell lung cancer, including:
- Cisplatin
- Carboplatin
- Paclitaxel
- Gemcitabine
- Vincristine
- Iritecan
- Etoposide
- Vincristine
- Pemetrexed
Usually, a combination of two drugs is also chosen for the treatment of non-small cell lung cancer, most commonly cisplatin or carboplatin plus another drug, usually a chemotherapeutic agent, and more recently a combination of immunologic agents is being tried.
The reason for highlighting the difference between small cell lung cancer and non-small cell lung cancer chemotherapy drugs is because I’ve seen some small cell lung cancer patients who are actually on expensive drugs like imported paclitaxel.
Clinical trials have shown that paclitaxel is no more effective than etoposide in the treatment of small cell lung cancer, but it is more than 10 or even tens of times more expensive. The indiscriminate use of drugs can significantly increase the “economic toxicity” of treatment, which means spending money that is not justified.
Lung cancer chemotherapy cycles and side effects
Regardless of the chemotherapy drug, it is given in cycles. Treatment usually lasts 1 to 3 days, followed by a break to allow the body to recover. A chemotherapy cycle is usually 3 to 4 weeks, and the initial treatment is usually 4 to 6 cycles. If it works, the entire cycle is completed, and if it progresses during treatment, or if it comes back after treatment ends, then other drugs are usually tried.
Besides hair loss, diarrhea, nausea and vomiting, there may be specific side effects from the chemotherapy drugs used for lung cancer. For example, cisplatin, vincristine, doxorubicin, or paclitaxel can cause nerve damage (peripheral neuropathy), such as causing pain, burning, or tingling in the hands and feet.
For most people, this goes away or gets better after treatment stops, but some people have it for a long time. It is important for people to report any side effects to their doctor in time for them to intervene promptly, including giving a reduced dose of chemotherapy drugs or delaying their dosing.
(Image from Station Cool Helo)
Summary
Chemotherapy drugs are not perfect, and side effects severely limit their use. But it is not simply a poison, nor is it useless. Recent studies have found that chemotherapy in lung cancer can also significantly increase the effectiveness of immunotherapy.
I hope that all lung cancer patients and families will try to understand the pros and cons of the various chemotherapy drugs and make a rational choice based on their health, financial situation, and treatment goals.
As researchers, our job is to work with doctors to research and develop better combinations of anti-cancer drugs to achieve lower side effects and better treatment outcomes.