Palliative chemotherapy – the rational choice for advanced lung cancer

Lung cancer has no obvious symptoms in its early stages, and because most people lack regular high-quality medical checkups, most lung cancer patients are diagnosed at an advanced stage, often with distant metastases to areas such as the liver, bone, and brain. At this point, many people fall into the abyss.

Auntie Su, 72, seems to be different from other patients, and she seems calm and peaceful in the face of the “verdict” of “late-stage lung cancer. “The company’s main business is to provide a wide range of products and services to its customers.

In fact, the old woman’s condition was not promising. Her diagnosis at the time of admission was extensive small cell lung cancer (SCLC), with brain and bone metastases that had lost any hope of a surgical cure.

Auntie Su was optimistic and sensible. Instead of giving up on treatment and demanding a cure, she actively cooperated with her doctors and received regular palliative chemotherapy – a reasonable way to avoid risks, improve existing symptoms and reduce some pain.

So, what is “palliative chemotherapy”?

So what is “palliative chemotherapy”?

What is palliative chemotherapy?

What is palliative chemotherapy?

We know that surgery, chemotherapy, and radiotherapy are the three main treatments for lung cancer. Surgery and radiotherapy are used for local treatment, while chemotherapy is a systemic treatment that kills tumor cells with drugs. Early-stage lung cancer is treated mainly with surgery, while chemotherapy is commonly used for advanced lung cancer.

Based on its role and nature, chemotherapy can be classified as radical, palliative, neoadjuvant, adjuvant, or investigational chemotherapy. Some tumors may be cured by chemotherapy alone, which is radical chemotherapy, such as lymphoma and acute lymphoblastic leukemia; some tumors (e.g., advanced lung cancer) cannot be cured by chemotherapy, but chemotherapy helps to reduce symptoms, improve quality of life, and extend life span appropriately, which is palliative chemotherapy.

When is palliative chemotherapy considered?

According to our lung cancer guidelines, palliative chemotherapy is the basic strategy of choice for stage IV (i.e., advanced) non-small cell lung cancer (NSCLC) without a driver gene; patients with advanced NSCLC with a driver gene may choose to take a targeted agent, but after resistance to targeted therapy, if there is no longer a targetable gene mutation, palliative chemotherapy is not a bad idea. Palliative chemotherapy is not a reasonable option.

For patients with extensive SCLC like Auntie Su, although the goal of chemotherapy is to eradicate the tumor, in practice most patients only live longer, so it is still palliative chemotherapy.

Chemotherapy is a double-edged sword, killing the tumor while also causing some damage to the body. Therefore, before deciding to administer palliative chemotherapy, doctors assess the patient’s physical status to determine if they can tolerate chemotherapy. One common tool is the PS (performance status) score.

Patients with poor PS scores have two general categories. One is only partially self-care, requiring bed or wheelchair use for more than half of the day; the other is bedridden and unable to care for themselves. The causes of this situation can be divided into two types: one is due to the tumor itself, and the other is due to other reasons other than the tumor. If the former is the case, the choice of palliative chemotherapy should be more cautious, and doctors usually use a reduced or single-dose regimen; if the latter is the case, an appropriate palliative chemotherapy regimen can be chosen after appropriate treatment.

Extended reading:

What is adjuvant chemotherapy?

Adjuvant chemotherapy is chemotherapy administered after the implementation of local treatment methods (surgery, radiation therapy, etc.) in order to minimize the risk of recurrence.

What is neoadjuvant chemotherapy?

Neoadjuvant chemotherapy is chemotherapy before the implementation of a local treatment approach, with the goal of shrinking and stabilizing the mass and helping with subsequent treatment.