Overview of treatment options for non-small cell lung cancer

There are different types of treatments for patients with non-small cell lung cancer.

There are multiple treatments for non-small cell cancer. Some are standard therapies (currently used treatments), and some are still in the testing phase of clinical trials. A clinical treatment trial is an investigational study to improve current treatments or to get information about novel treatments for people with cancer. If the clinical trial shows that the new treatment is superior to the current standard of care, then the new treatment can be used as the standard of care. Patients may also want to be enrolled in a clinical trial. And some clinical trials are only for patients who have not yet been treated.

Ten standard treatments

Surgery

Four types of surgery for lung cancer:

Lung wedge resection: a procedure that removes the tumor and some of the surrounding normal tissue. A segmental lung resection requires removal of more normal tissue. Wedge resection of the lung; shows trachea and lungs with cancer in a lung lobe. The removed lung tissue with the cancer and small amount of The removed lung tissue with the cancer and small amount of healthy tissue around it is shown next to the lung lobe it was removed from.

Wedge resection of the lung; shows trachea and lungs with cancer in a lung lobe. The removed lung tissue with the cancer and small amount of The removed lung tissue with the cancer and small amount of healthy tissue around it is shown next to the lung lobe it was removed from.

Wedge resection of the lung. A portion of the lobe containing the cancer cells and a small amount of surrounding healthy tissue was removed.

Lobectomy: An operation to remove an entire lobe of the lung . Lobectomy; drawing shows lobes of both lungs, trachea, bronchi, bronchioles, and lymph nodes. cancer is shown in one lobe. the removed lobe The removed lobe is shown next to the lung from which it was removed.

Lobectomy; drawing shows lobes of both lungs, trachea, bronchi, bronchioles, and lymph nodes. cancer is shown in one lobe. the removed lobe The removed lobe is shown next to the lung from which it was removed.

Lobectomy. Removal of one lobe of the lung

Total pneumonectomy: A procedure to remove the entire side of the lung. Pneumonectomy; drawing shows the trachea, lymph nodes, and lungs, with cancer in one lung. The removed lung with the cancer is shown.

Pneumonectomy; drawing shows the trachea, lymph nodes, and lungs, with cancer in one lung. The removed lung with the cancer is shown.

Total pneumonectomy. Removal of the entire side of the lung

Sleeve resection: a procedure to remove part of the bronchus.

Even if the surgeon removes all of the cancerous tissue that can be seen during surgery, some patients still need chemotherapy or radiation therapy after surgery to kill any remaining cancer cells. Adjuvant therapy is treatment that reduces the risk of cancer recurrence after surgery.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or stop them from growing. There are two types of radiation therapy:

Ex vivo radiation therapy uses a machine outside the body to send radiation to the cancer site.

In vivo radiation therapy seals a radioactive substance in a needle, seed, wire, or catheter and places it directly in or near the cancer site.

Stereotactic body radiation therapy is a form of external radiation therapy. Special equipment is used to place the patient in the same position for each radiation treatment. The radiation machine delivers radiation directly to the tumor site at a larger than usual dose of radiation once a day for several days. Having the patient in the same position for each treatment reduces damage to nearby healthy tissue. This procedure is also referred to as stereotactic external radiation therapy and stereotactic radiation therapy.

Stereotactic radiosurgery is a type of external radiation therapy used to treat lung cancer that has spread to the brain. During radiation therapy, a rigid head frame is fixed to the skull to keep the head still. The machine directs a single large dose of radiation directly at the tumor in the brain. This procedure does not require surgery. It is also known as radiosurgery.

For tumors in the airway, the tumor can be treated with radiation directly to the tumor through the endoscope.

The type of radiation therapy depends on the staging and staging of the cancer. It also depends on the location of the cancer. Non-small cell lung cancer is treated with external and internal radiation therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cancer cells or by stopping them from dividing. Administered by mouth or intravenously or intramuscularly, the drugs can enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy drugs are given directly into the cerebrospinal fluid, organs, or body cavities such as the abdominal cavity, the drugs work mainly on cancer cells in these areas (local chemotherapy).

The type of chemotherapy depends on the staging and stage of the cancer to be treated.

For more information, see Drug approval for non-small cell lung cancer.

Targeted therapy

Targeted therapy is a treatment that uses a drug or other substance to attack specific cancer cells. Targeted therapy usually causes less harm to normal cells than chemotherapy or radiation therapy. Monoclonal antibodies and tyrosine kinase inhibitors are the two main types of targeted therapy used to treat advanced, metastatic, or recurrent non-small cell lung cancer.

Monoclonal antibody therapy is a method of treating cancer using antibodies grown in vitro from a single type of immune cell. These antibodies recognize specific sites on cancer cells or normal factors from the blood or tissues that can promote cancer cell growth. When the antibodies bind to these substances, they can cause the cancer cells to die, or inhibit their growth, or stop them from spreading. A monoclonal antibody needs to be injected into the body to work. It can be used alone, or it can transport drugs, toxins, or radioactive material directly to cancer cells.

There are several different monoclonal antibodies

Vascular endothelial growth factor (VEGF) inhibitor therapy:Cancer cells produce a substance called VEGF, which promotes the formation of new blood vessels (angiogenesis) and helps cancer cells grow.VEGF inhibitors block VEGF and stop the formation of new blood vessels. This may kill cancer cells because they need new blood vessels to grow. Bevacizumab and ramolutumab are VEGF inhibitors and angiogenesis inhibitors.

Epidermal growth factor receptor (EGFR) inhibitor therapy:EGFR is a protein found on the surface of certain cells, including cancer cells. Epidermal growth factor attaches to the epidermal growth factor receptor on the cell surface, causing the cells to grow and divide. EGFR inhibitors block the receptor, preventing epidermal growth factor from attaching to cancer cells. This stops the cancer cells from growing and dividing. Cetuximab and nexituzumab are EGFR inhibitors.

Tyrosine kinase inhibitors are small molecule drugs that work across cell membranes and inside cancer cells, blocking the signals needed for cancer cells to grow and divide. Some tyrosine kinase inhibitors also have angiogenesis-inhibiting effects.

There are different types of tyrosine kinase inhibitors:

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors:EGFR is a protein found on the surface and inside of certain cells, including cancer cells. Epidermal growth factor attaches to EGFR inside cells and sends signals to the tyrosine kinase region of the cell, prompting cell growth and division. EGFR tyrosine kinase inhibitors block these signals, which in turn stop cancer cells from growing and dividing. Erlotinib, gefitinib, afatinib and axitinib are different EGFR tyrosine kinase inhibitors. Some of these drugs work better when there are mutations (changes) in the EGFR gene.

Kinase inhibitors can affect cells with specific genetic alterations:Certain changes in the ALK, ROS1, BRAF, and MEK genes, as well as NTRK fusion genes, can lead to the production of too many proteins. Blocking these proteins can stop the growth and spread of cancer. Crizotinib is used to stop the synthesis of proteins from the ALK and ROS1 genes. Ceritinib, erlotinib, bucatinib, and loratanib are used to stop the ALK gene from producing proteins. Darafenib is used to block protein production by the BRAF gene. Tramitinib is used to block the production of proteins by the MEK gene. Larotinib is used to stop the protein produced by the NTRK fusion gene.

For more information, see Drug approval for non-small cell lung cancer.

Immunotherapy

Immunotherapy is a therapy that uses the patient’s immune system to fight cancer. Substances produced by the body or prepared in the laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also known as biologic therapy.

Immune checkpoint inhibitor therapy is a type of immunotherapy:

Immune checkpoint inhibitor:PD-1 is a protein that sits on the surface of T cells and helps control the body’s immune response. When PD-1 binds to another protein on cancer cells called PDL-1, it prevents T cells from killing cancer cells.PD-1 inhibitors combine with PDL-1 to allow T cells to kill cancer cells. Pabrolizumab, atezumab, and devaluzumab are a few of the immune checkpoint inhibitors. Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells.

Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells.

Immune checkpoint inhibitors. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help suppress the immune response. the binding of PD-L1 to PD-1 prevents T cells from killing tumor cells in the body (left). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows T cells to kill tumor cells (right).

Immunotherapy uses the body’s immune system to fight cancer. This animation explains an immunotherapy treatment that uses immune checkpoint inhibitors to treat cancer.

For more information, see Drug approval for non-small cell lung cancer.

Laser therapy

Laser therapy uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Photodynamic therapy (PDT)

Photodynamic therapy uses a combination of drugs and some type of laser light to kill cancer cells. The drug injected into the blood vessels is activated by the irradiation. The drug aggregates more at the cancer cells and less at the normal tissue. The laser beam is delivered to the cancer cells through a light-guided fiber tube, causing the drug to be activated and kill the cancer cells. Photodynamic therapy is less harmful to healthy tissue. It is mainly used to treat tumors located in the skin or only in the subcutaneous or visceral layers. If the tumor is located in the airway, PDT will be guided directly to the tumor through the endoscope.

Cryosurgery

Cryotherapy is the use of instruments to freeze abnormal tissue, such as carcinoma in situ, and cause it to necrotize. This treatment is also called cryotherapy. If the tumor is located in the airway, cryosurgery can be done endoscopically.

Electrocautery

Electrocautery uses a probe or puncture needle that has been heated by an electric current to destroy abnormal tissue. If the tumor is located in the airway, electrocautery can be done endoscopically.

Wait-and-see

Wait-and-see refers to monitoring the patient’s condition only when signs and symptoms are not present or changing, without giving him or her any therapeutic measures. This is only for certain rare cases of non-small cell lung cancer.

New therapies are in the testing phase of clinical trials.

This section of the overview is a description of the treatments being studied in clinical trials. This article may not cover all of the novel therapies being studied. Information about clinical trials can be found at the NCI Web site.

Chemoprevention

Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of getting cancer or to reduce the risk of cancer coming back. For lung cancer, chemoprevention is used to reduce the chance of new tumors forming in the lungs.

Radiation sensitizers

Radiation sensitizers are substances that make tumor cells easier to kill by radiation therapy. In the treatment of non-small cell lung cancer, the effects of giving radiosensitizers in combination with chemotherapy and radiation therapy are being studied.

New combinations of

novel combination therapies are in the research phase of clinical trials.

Treatment for non-small cell lung cancer may cause side effects.

For information about side effects of cancer treatment, see our side effects page.

Patients may want to consider enrolling in a clinical trial.

For some patients, participating in a clinical trial may be the best treatment option. Clinical trials are part of the cancer research process. The purpose of a clinical trial is to determine if a new therapy is safe and effective or better than standard therapy.

Many of the standard therapies now available are based on the results of previous clinical trials. Patients who participate in clinical trials may receive the standard treatment or they may be the first to receive the new therapy.

Patients who participate in clinical trials can also help improve the way cancer is treated in the future. Even if an effective new treatment is not studied, clinical trials often address important questions and advance research.

Patients can enter a clinical trial before, during, or after starting cancer treatment.

Some clinical trials allow only untreated patients to participate. Some trials are for patients with cancer that has not improved. Still other clinical trials are designed to study new measures to prevent the cancer from coming back (reoccurring) or to reduce the side effects of cancer treatment.

Clinical trials are being conducted in many parts of the country. Information about NCI-supported clinical trials can be found on the NCI’s Clinical Trials Search website. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed

Confirming a diagnosis of cancer or determining its stage may require repeat tests. Multiple tests should also be performed to determine the effectiveness of treatment. The results of these tests will determine if treatment needs to be continued, or if the treatment plan needs to be changed.

There are ongoing tests that will be done after treatment ends. The results of these tests can show whether your health has changed or whether the cancer has come back (recurred). These tests are called follow-up tests or rechecks.