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 type of cancer and 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 80 percent to 85 percent of lung cancer cases and SCLC accounts for 10 percent to 15 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 or tumors
• Whether the cancer has metastasized (spread)
• Any genetic mutations (changes) present in the tumor

Types of Treatments 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 at risk for COVID-19 to ensure their general 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, the stage of your cancer, and your overall health. Lung cancer surgeries are usually performed by thoracic surgeons.

• Lobectomy — The most commonly performed surgery for lung cancer, where an entire lung lobe affected by cancer is removed
• Pneumonectomy — Involves the removal of a whole lung, typically used when the cancer cannot be removed with a lobectomy or when it is centrally located in the lung
• Segmentectomy — Entails removing one to four segments of one lung lobe to preserve as much healthy tissue as possible
• Wedge resection — Involves the removal of a small, wedge-shaped piece of lung tissue surrounding the tumor
• Sleeve resection — Involves removing cancerous tissue or a tumor without removing an entire lung
• Video-assisted thoracic surgery (VATS) — A minimally invasive surgery in which a tiny camera guides surgeons who use hand-guided tools inserted through small incisions in the chest wall
• Robotically assisted thoracic surgery (RATS) — Involves performing surgery with a camera and robotic instruments inserted through small chest wall incisions

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 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’s much more concentrated for cancer treatment. Radiation treatment 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.

Proton therapy is a newer type of radiation therapy that is more precise than traditional radiotherapy. It’s an option for people with certain types of lung cancer, though it may not be available in all areas.

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 can’t 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 for lung cancer refers to types 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 molecular inhibitors have been developed to target EGFR mutations, such as:

• Afatinib (Gilotrif)
• Amivantamab-vmjw (Rybrevant)
• Dacomitinib (Vizimpro)
• Erlotinib
• Gefitinib (Iressa)
• Necitumumab (Portrazza)

These small molecular 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 don’t smoke or who smoke lightly. Small molecule inhibitors that treat ALK mutations include:

• Alectinib (Alecensa)
• Brigatinib (Alunbrig)
• Ceritinib (Zykadia)
• Crizotinib (Xalkori)
• Lorlatinib (Lorbrena)

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’s usually seen in people with NSCLC who do not have EGFR, ALK, or KRAS mutations.

Medications that target the ROS1 gene rearrangement include:

• Ceritinib
• Crizotinib
• Entrectinib (Rozlytrek)
• Lorlatinib
• Repotrectinib (Augtyro)

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. These drugs work to inhibit the function of NRTK proteins for people whose lung cancer carries this gene mutation:

• Entrectinib
• Larotrectinib (Vitrakvi)
• Repotrectinib

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. Tepotinib hydrochloride (Tepmetko) also blocks the function of MET proteins.

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. Inhibitors used to treat these mutations include:

• Dabrafenib (Tafinlar)
• Encorafenib (Braftovi)
• Vemurafenib (Zelboraf)

Binimetinib (Mektovi) and trametinib (Mekinist) are often used alongside encorafenib. It’s a kinase inhibitor that helps prevent cancer cell growth.

KRAS G12C Inhibitors

The KRAS gene can control how fast cancer cells divide and spread. The G12C mutation keeps that process turned on, instead of cycling it on and off as the body needs to. Adagrasib (Krazati) and sotorasib (Lumakras) target the KRAS G12C mutation and are sometimes used along with other targeted therapies.

TP53 Mutations

Tumor protein p53 (TP53) is a gene that encodes for the protein p53. This means that the TP53 gene contains the instructions necessary to make the p53 protein. This protein is found in the nucleus of the cell and helps repair damaged DNA.

When healthy immune cells sense this damage, p53 turns on other genes to help repair the DNA. In lung cancer cells, however, p53 is often mutated so it can’t help repair damaged DNA. P53 mutations are almost always found in cases of SCLC but can also occur in NSCLC.

Currently, there are no targeted therapies approved by the U.S. Food and Drug Administration (FDA) for people with lung cancer caused by TP53 mutations. However, several promising treatment options are under review in oncology clinical trials — cancer research studies that test new treatments to see if they are safe and effective for people with cancer. Other targeted therapies have been approved for TP53 mutations associated with other conditions. Before health professionals can prescribe these therapies for lung cancer, more research is needed to confirm they are safe and effective.

Other Types of Targeted Therapy

Doctors and researchers are developing new types of targeted therapy all the time. One drug they’ve found is fam-trastuzumab deruxtecan-nxki (Enhertu), which targets NSCLC that has specific mutations to the HER2 gene.

Immunotherapy for Lung Cancer

Immunotherapy for lung cancer is a relatively recent treatment advancement. 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. These are called “checkpoint inhibitors.”

PD-1 Inhibitors

PD-1 is one of the checkpoints that can be targeted by immunotherapy medications. These are options when you need to block this protein:

• Cemiplimab (Libtayo)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)

PD-L1 Inhibitors

PD-L1 works with PD-1 and can also be blocked. Atezolizumab (Tecentriq), atezolizumab and hyaluronidase-tqjs (Tecentriq Hybreza), and durvalumab (Imfinzi) target the PD-L1 protein found on cancer cells, blocking it and leaving the cells more vulnerable to immune system attack.

CTLA-4 Inhibitor

CTLA-4 is another immune checkpoint found on T cells. When this binds to the protein B7 found on tumor cells, it shuts down the T cell and prevents it from creating an immune response.

Ipilimumab (Yervoy) is a CTLA-4 inhibitor that blocks the interaction between CTLA-4 and B7. This leaves the T cell active, so it can activate the immune system to kill the tumor cells. This therapy is currently only approved in combination with other therapies for treating certain cases of NSCLC. Tremelimumab-actl (Imjudo) is another drug that targets the CTLA-4 pathway. It’s used for people with NSCLC that has spread and who have not received treatment before.

Other Immunotherapy Drugs

Researchers are developing new immunotherapy drugs all the time. One, tarlatamab-dlle (Imdelltra), brings lung cancer cells and the immune system cells that kill them closer together by binding to both of them.

Palliative Care

Palliative care for lung cancer focuses on treatments and medications that help relieve symptoms and improve quality of life during any stage of the disease. Palliative care doesn’t treat the cancer itself but, rather, symptoms caused by cancer or side effects of treatment.

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.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 13,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

What treatments have you tried for lung cancer? What questions do you have? Share your experience in the comments below, or start a conversation by posting on your Activities page.