Chemotherapy is an important tool in the treatment of lung cancer. Its status and role vary in different treatment modalities. Suffice it to say that chemotherapy plays an important role in reducing recurrence rates and prolonging survival, and is indispensable in the comprehensive treatment of lung cancer.
Focus on reducing recurrence and prolonging survival
For advanced lung cancer that is driver-negative (inoperable), chemotherapy is the cornerstone of treatment and plays an important role in prolonging life, whereas for lung cancer that is operable, chemotherapy is often an adjuvant therapy that can play a role in prolonging recurrence-free survival but is not the primary mode of treatment.
For example, chemotherapy is not routinely needed after surgery for stage I non-small cell lung cancer (NSCLC); for stage IIIA NSCLC, chemotherapy is often used in combination with radiotherapy; for stage IIIB, chemotherapy combined with radiotherapy is also a treatment strategy of choice.
For certain tumors, such as lymphoma, leukemia and other hematologic tumors, chemotherapy can be curative for some patients. However, for lung cancer, both in operable and advanced lung cancer, the role is relatively limited and it is often difficult to achieve radical lung cancer cure with chemotherapy. A special case is small cell lung cancer (SCLC) with T1/2N0M0, for which surgery combined with chemotherapy can be curative.
Principles of chemotherapy
Not all patients with lung cancer need chemotherapy. For example, postoperative adjuvant chemotherapy is generally not recommended for stage I NSCLC, as mentioned above, unless there are high-risk factors.
So which patients need chemotherapy? To “choose the right person,” a pre-chemotherapy evaluation is critical.
The first factor that doctors usually consider is whether the patient is physically able to tolerate chemotherapy. For example, patients can take care of themselves in daily life, or engage in simple physical activities, and do not need to be bedridden for a long time every day. Patients with poorer physical status will have less benefit from chemotherapy.
Secondly, the metabolic mechanism of chemotherapy drugs in the body determines that patients should have good liver and kidney function, bone marrow hematopoietic function, etc. should be basically at normal level, etc.
In addition, some co-morbidities can also have an impact on chemotherapy, for example, having acute phase thrombosis, recent hemoptysis, intestinal obstruction, etc. These factors can affect the chemotherapy delivery.
Adverse effects are gradually decreasing
Chemotherapy is a double-edged sword, and while it is effective, it also brings with it certain adverse effects.
However, with the continuous updating of chemotherapy drugs and the clinical application of symptomatic support drugs, the adverse effects of chemotherapy are becoming less and less severe. At present, China is gradually starting to use some methods to focus on the control of adverse reactions. For example, “vomit-free chemotherapy”, doctors use a combination of multiple drugs to prevent nausea and vomiting to help patients pass through chemotherapy peacefully; by strengthening the regulation of patients’ psychological and physiological functions, patients no longer fear chemotherapy, etc.. These methods have reduced the adverse effects of chemotherapy and also improved patients’ confidence, maximizing the effects of chemotherapy.
Co-reviewed by: Dr. Haiyan Tu, Deputy Chief Physician, Guangdong Provincial People’s Hospital Guangdong Lung Cancer Research Institute Dr. Yue-Li Sun, Dr. Xiang-Meng Li