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Treatments for Lung Cancer

Medically reviewed by Todd Gersten, M.D.
Written by Emily Wagner, M.S.
Updated on April 7, 2021

Treatment options for lung cancer may include surgery, chemotherapy, radiation therapy, targeted medications, and immunotherapy, or combinations of these treatments. Palliative therapy does not treat lung cancer itself, but manages symptoms to improve quality of life. Doctors recommend treatment plans for lung cancer based on which options will be safest and most effective given the specific factors involved in each case.

Factors in Treatment Options

Treatment options for lung cancer depend first on the type of lung cancer you have. The two main types of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Overall, NSCLC accounts for 84 percent of cases, and SCLC 13 percent. While most treatment options overlap, NSCLC and SCLC ultimately are different diseases that have separate therapies.

Your cancer care team will consider many factors when planning lung cancer treatment:

  • Age and overall health
  • Assessment of lung function
  • Stage of the tumor
  • Location and size of the tumor
  • Whether the cancer has spread (metastasis)
  • Any genetic mutations present in the tumor

Treatment Options for Lung Cancer

Treatment options will be different for every case of lung cancer. Options available to treat both NSCLC and SCLC include surgery, radiation, chemotherapy, and immunotherapy, as well as palliative care to improve quality of life. Targeted therapies have also been developed to treat NSCLC.

Most treatments will be administered at a cancer center or as outpatient procedures. Special considerations are made for people undergoing treatment for lung cancer during the COVID-19 pandemic to ensure their health and safety.

Who Treats Lung Cancer?

A comprehensive team of health care professionals will determine a treatment plan best suited for you. Specialists on a lung cancer care team may include:

  • Thoracic surgeons, who specialize in surgeries for diseases in the lungs and chest
  • Medical oncologists, who treat cancer and will develop a medication plan
  • Radiation oncologists, who treat cancer with radiation therapy
  • Pulmonologists, who specialize in treating lung conditions
  • Oncology nurses

Doctors and nurses on your cancer care team will work together to develop a treatment plan designed to meet your needs, but treatment decisions are ultimately up to you.

Surgeries for Lung Cancer

Surgery is often considered to be the best option when a tumor has not spread, as in some cases of early stage NSCLC and carcinoid tumors. The type of lung cancer surgery will depend on the size of the tumor, its location and stage, and your overall health.

Lobectomy

A lobectomy is the most commonly performed surgery to treat lung cancer. In this surgery, an entire lung lobe affected by cancer is removed. The left lung has two lobes, and the right lung has three. A bilobectomy involves removal of two lobes. This is only done for tumors in the right lung that affect lobes next to each other.

Pneumonectomy

A pneumonectomy is the removal of an entire lung. This is performed in cases where the cancer cannot be removed with a lobectomy alone or where the tumor is centrally located in the lung.

Segmentectomy

Each lung lobe has three to five lung segments. Depending on the tumor’s location in the lung, a surgeon can remove between one and four segments in certain lobes, preserving the unaffected tissue.

Wedge Resection

A wedge resection involves removal of a small, wedge-shaped piece of lung tissue that surrounds a tumor.

Sleeve Resection

A sleeve resection is a two-part procedure that begins with removal of the lung lobe containing the tumor and part of the main bronchus in that lung. Then, the remaining piece of the bronchus is attached to another bronchus in a healthy lobe. A successful sleeve resection can prevent the need to remove an entire lung.

Minimally Invasive (Assisted) Surgeries

Video-assisted thoracic surgery (VATS) is a minimally invasive surgery used to treat lung cancer. A tiny camera (thoracoscope) and surgical tools are inserted through one or more small incisions in the chest wall. The camera allows doctors to see inside the chest cavity, which guides the surgical process.

During robotically assisted thoracic surgery (RATS), a surgeon sits at a console in the operating room and controls robotic instruments during the procedure. A camera is inserted through a small incision (similar to VATS) to help the surgeon see inside the chest cavity. The robotic instruments are inserted into another incision and are guided to remove tissue or perform other procedures.

Chemotherapy for Lung Cancer

Chemotherapy is a broad term used to describe drugs that target and kill rapidly dividing cells in the body. Chemotherapy drugs are typically given through an intravenous (IV) infusion, allowing the drugs to travel through the bloodstream and reach almost every part of the body to kill cancer cells. There are different chemotherapy regimens to treat NSCLC or SCLC.

Radiation Therapy for Lung Cancer

Radiation therapy, also known as radiotherapy, uses an intense beam of radiation to kill cancer cells and shrink tumors. The type of radiation is similar to that used in X-rays, but it is much more concentrated for cancer treatment. This therapy works by damaging the DNA of cancer cells beyond repair, causing the cells to die or to stop dividing. There are different radiotherapy regimens used to treat NSCLC or SCLC.

Radiofrequency Ablation

Radiofrequency ablation (RFA) may be an option for some people with small tumors located near the outer edge of the lungs, particularly if they cannot undergo surgery. In RFA, CT scans are used to guide the placement of a thin, needle-like probe into the tumor. Then high-energy radio waves are sent through the probe to heat the tumor and destroy the cancer cells.

Targeted Drug Therapy

Targeted therapy refers to the class of drugs that work by “targeting” specific mutations or growth factors in cancer. Because these drugs are so specific, they minimize damage to healthy cells and cause fewer side effects. Targeted therapy is used specifically for the treatment of NSCLC. Cancer cells can be tested for biomarkers to see if any of the following medications will be effective against them.

Angiogenesis Inhibitors

Vascular endothelial growth factor (VEGF) is responsible for initiating the growth of new blood vessels in a process called angiogenesis. Large tumors need their own blood supply in order to absorb oxygen and nutrients. As a result, some cancer cells have learned to make their own VEGF to grow new blood vessels.

Bevacizumab (Avastin) and ramucirumab (Cyramza) are monoclonal antibody drugs that work by blocking VEGF from binding to its receptor, stopping the tumor from forming its own new blood vessels.

EGFR Inhibitors

Epidermal growth factor receptor (EGFR) is one of the most common mutations in NSCLC. Small-molecule inhibitors have been developed to target EGFR mutations, such as:

  • Erlotinib (Tarceva)
  • Afatinib (Gilotrif)
  • Gefitinib (Iressa)
  • Dacomitinib (Vizimpro)

These small-molecule inhibitors can shrink tumors for an extended period of time. However, for many taking these medications, the cancer cells eventually acquire another EGFR mutation and the medication stops working. Osimertinib (Tagrisso) is another EGFR inhibitor that specifically targets one of these acquired EGFR mutations, the T790M mutation.

ALK Inhibitors

In around 5 percent of NSCLC cases, the ALK gene is mistakenly moved to a different part of the chromosome, resulting in a gene rearrangement. This makes an abnormal ALK protein that tells cells to rapidly grow and divide, resulting in a tumor. The ALK gene rearrangement is usually seen in younger adults who are nonsmokers or light smokers. Small-molecule inhibitors that treat ALK mutations include:

ROS1 Inhibitors

ROS1 gene rearrangements can occur in a similar fashion to those seen with the ALK gene and can sometimes be treated with the same targeted therapies. The ROS1 rearrangement is present in between 1 percent and 2 percent of NSCLC cases. It is usually seen in people with NSCLC who do not have EGFR, ALK, or KRAS mutations. Medications that target the ROS1 gene rearrangement include:

  • Entrectinib (Rozlytrek)
  • Crizotinib (Xalkori)
  • Ceritinib (Zykadia)
  • Lorlatinib (Lorbrena)

NRTK Inhibitors

In a small number of NSCLC cases, there are mutations in one of the NRTK genes that cause cells to rapidly grow and divide. Entrectinib (Rozlytrek) and Larotrectinib (Vitrakvi) both work to inhibit the function of NRTK proteins for people whose lung cancer carries this gene mutation.

RET Inhibitors

In a handful of NSCLC cases, mutations in the RET gene produce a protein that causes cancer cells to grow. Two inhibitors have been developed to block the function of the RET protein: Selpercatinib (Retevmo) and Pralsetinib (Gavreto).

MET Inhibitors

In some cases of NSCLC, a MET gene mutation produces a protein that encourages tumor cells to spread and grow. Capmatinib (Tabrecta) directly blocks the function of MET proteins. Tabrecta can be used to treat metastatic NSCLC if tumors have changes in the MET gene.

BRAF Inhibitors

In some cases of NSCLC, there may be BRAF gene mutations that tell cells to rapidly grow and divide, leading to tumor growth. Two inhibitors used to treat these mutations are Dabrafenib (Tafinlar), which targets BRAF directly, and Trametinib (Mekinist), which targets the related proteins MEK.

Immunotherapy for Lung Cancer

Immunotherapy is a relatively recent advancement in the treatment of cancer. Immunotherapy uses bioengineered immune proteins known as antibodies that help activate the immune system to target and kill cancer cells. Because immunotherapy treatments consist of one type of antibody only, they are known as monoclonal antibodies. They are also referred to as biologics. Immunotherapy targets specific cells in the body, which helps avoid many of the side effects seen in treatments like chemotherapy.

Immunotherapy can be used to treat both NSCLC and SCLC. The therapies focus on interrupting communication between cancer cells and T cells, which are important cells in the immune system. The immune system produces “checkpoint” proteins that help prevent it from attacking normal cells in the body. Some cancer cells can hijack the checkpoint system to avoid being seen and destroyed by the immune system.

Fortunately, monoclonal antibodies have been developed that prevent this type of communication through these checkpoints. Nivolumab (Opdivo) and Pembrolizumab (Keytruda) target the PD-1 protein found on T cells, boosting the immune system’s response to the cancer cells. Atezolizumab (Tecentriq) and Durvalumab (Imfinzi) target the PD-L1 protein found on cancer cells, blocking it and leaving the cells more vulnerable to immune system attack.

Ipilimumab (Yervoy) targets CTLA-4, a protein found on T cells. CTLA-4 is another type of checkpoint that can be exploited by cancer cells, and blocking it boosts the immune system to shrink tumors. This therapy is currently only approved in combination with other therapies for treating certain cases of NSCLC.

Palliative Care

Palliative care focuses on treatments and medications that help relieve symptoms of lung cancer and improve a person’s quality of life during any stage of cancer. These treatments do not treat the cancer itself, but rather symptoms caused by cancer.

Palliative care options are fairly similar between NSCLC and SCLC:

  • Thoracentesis — A hollow needle is inserted in between the ribs to remove fluid buildup around the lungs.
  • Pleurodesis — A hollow tube is placed inside the chest. Substances, like talc or certain chemotherapy drugs or antibiotics, are placed into the chest to seal the space between the chest wall and lung lining to prevent fluid buildup.
  • Catheter placement — A thin, flexible tube known as a catheter is inserted into the chest through a small incision. The other end remains outside of the body and is attached to a bottle that collects excess fluid surrounding the lungs.
  • Pericardiocentesis — Guided by an echocardiogram (EKG), a needle is inserted into the space around the heart to drain excess fluid.
  • Pericardial window — To prevent fluid buildup around the heart, a surgeon can create a pericardial window by removing a piece of the heart’s covering (known as the pericardium) to allow fluid to drain into the chest or abdomen.
  • Laser therapy — A laser attached to long, thin instruments is guided into the airways to burn tumor tissue, opening the airways for easier breathing.
  • Stent placement — A metal or silicone tube (stent) is placed in an airway blocked by a lung tumor to open it up.
  • Photodynamic therapy — A light-activated drug, Photofrin (porfimer sodium) is injected and taken up by cancer cells. After a few days, a special tool called a bronchoscope is guided down the throat and into the lung. A laser light on the end of the bronchoscope is aimed at the tumor, which activates the drug and kills the cancer cells.

Can Lung Cancer Be Cured?

Lung cancer treatments continue to improve over time. Whether a case of lung cancer is curable or not depends on many factors. In some cases, surgery with radiation and/or chemotherapy can provide remission for NSCLC or SCLC.

Lung Cancer Condition Guide

References
  1. If You Have Non-Small Cell Lung Cancer — American Cancer Society
  2. If You Have Small Cell Lung Cancer — American Cancer Society
  3. Health Professionals Associated With Cancer Care — American Cancer Society
  4. Treating Non-Small Cell Lung Cancer — American Cancer Society
  5. Treating Small Cell Lung Cancer — American Cancer Society
  6. Lung Cancer Surgery — American Lung Association
  7. Video-Assisted Thoracoscopic Surgery (VATS) — Mayo Clinic
  8. Minimally Invasive Thoracic Surgery — American Lung Association
  9. Radiofrequency Ablation (RFA) for Non-Small Cell Lung Cancer — American Cancer Society
  10. Radiation Therapy — Mayo Clinic
  11. Radiation Therapy for Non-Small Cell Lung Cancer — American Cancer Society
  12. Radiation Therapy for Small Cell Lung Cancer — American Cancer Society
  13. How Is Chemotherapy Used To Treat Cancer? — American Cancer Society
  14. Chemotherapy for Non-Small Cell Lung Cancer — American Cancer Society
  15. Chemotherapy for Small Cell Lung Cancer — American Cancer Society
  16. Targeted Therapy — National Cancer Institute
  17. Bevacizumab in the Treatment of NSCLC: Patient Selection and Perspectives — Lung Cancer: Targets and Therapy
  18. Clinical Utility of Ramucirumab in Non-Small Cell Lung Cancer — Biologics: Targets and Therapy
  19. Monoclonal Antibody Drugs for Cancer: How They Work — Mayo Clinic
  20. What Is EGFR-Positive Lung Cancer and How Is It Treated? — Lung Cancer Foundation of America
  21. Osimertinib Improves Survival in Advanced Lung Cancer With EGFR Mutations — National Cancer Institute
  22. Targeted Drug Therapy for Non-Small Cell Lung Cancer — American Cancer Society
  23. Immunotherapy for Non-Small Cell Lung Cancer — American Cancer Society
  24. Immunotherapy for Small Cell Lung Cancer — American Cancer Society
  25. Ipilimumab: Its Potential in Non-Small Cell Lung Cancer — Therapeutic Advances in Medical Oncology
  26. Palliative Procedures for Non-Small Cell Lung Cancer — American Cancer Society
  27. Palliative Procedures for Small Cell Lung Cancer — American Cancer Society
Updated on April 7, 2021
All updates must be accompanied by text or a picture.

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Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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