Drug therapies for lung cancer

Sometimes called systemic therapies, drug therapies can travel throughout the body to treat cancer cells wherever they may be. This can be helpful for cancer that has spread (metastatic cancer). The main types of drug therapies used to treat lung cancer are chemotherapy, immunotherapy and targeted therapy.

Having drug therapies

Some drug therapies are given through a vein (intravenously). You will probably have drug therapies as an outpatient, which means you go to a treatment centre, but not stay overnight. Some types of targeted therapy come as tablets and can be taken by mouth (orally) at home.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells or slow their growth. Chemotherapy can be used at different times:

• before surgery to try to shrink the cancer and make it easier to remove (neoadjuvant chemotherapy)
• before, or in combination with, radiation therapy to make radiation therapy more effective (chemoradiation); or in combination with immunotherapy
• after surgery to reduce the risk of the cancer returning (adjuvant chemotherapy)
• when cancer is advanced – to reduce symptoms and improve quality of life (palliative chemotherapy).

Chemotherapy given to treat lung cancer is usually one, two or three drugs together or one by itself. Drugs are commonly given as a period of treatment followed by a break to allow your body to recover. This is called a cycle. The number of cycles will depend on the type of lung cancer and any side effects you have.

Side effects of chemotherapy

Chemotherapy works on cells that are dividing rapidly. Cancer cells divide rapidly, as do some healthy cells such as the cells in your blood, mouth, digestive system and hair follicles. Side effects occur when these normal cells are damaged. As the body constantly makes new cells, most side effects are temporary. Some side effects are listed below.

Find out more at Chemotherapy, Mouth health and cancer treatment and Hair loss, and listen to Cancer Council's Appetite Loss and Nausea podcast episode.

Immunotherapy

This is a type of drug treatment that uses the body’s own immune system to fight cancer. Immunotherapy drugs, also known as immune checkpoint inhibitors, block proteins, such as PD-L1, that stop immune cells from recognising and destroying the cancer cells. Once the proteins are blocked, the immune cells can potentially recognise and attack the lung cancer.

Several checkpoint inhibitors have been approved for most types of advanced NSCLC and for SCLC when it is used together with chemotherapy. Several other checkpoint inhibitors are being tested in clinical trials for lung cancer, including using a combination of these drugs.

Checkpoint inhibitors do not work for all types of lung cancer, but some people have good results. Ask your oncologist about molecular testing and whether immunotherapy may be right for you.

Immunotherapy may be used alone, or with chemotherapy as a palliative treatment, or after chemoradiation.

Immunotherapy is now being used for some people with stage 2 NSCLC, either before or after surgery. Tell your medical team if you have an autoimmune disease as this might mean this treatment is not suitable.

Side effects of immunotherapy

Immunotherapy can cause an inflammatory response in various parts of the body, which leads to different side effects depending on which part of the body becomes inflamed.

Common side effects include fatigue, rash, diarrhoea and joint pain. Most people have mild side effects that can be treated easily and usually improve.

Let your treatment team know if you have new or worsening side effects. If left untreated, some side effects can become serious and may even be life-threatening. For a detailed list of side effects, visit NSW Government's eviQ.

Targeted therapy

Targeted therapy is a type of drug treatment that attacks specific features of cancer cells, known as molecular targets, to stop the cancer growing and spreading. The molecular targets are usually particular protein changes that are found in or on the surface of the cancer cells as a result of abnormal genes.

Targeted therapies are currently mostly available for people with NSCLC whose tumours have specific gene changes when the cancer is advanced or has come back after initial surgery or radiation therapy. These drugs will only work if the cancer contains the particular gene targeted and, even then, they do not work for everyone. Ask your oncologist about molecular testing and whether targeted therapy is an option for you.

For some abnormal genes, targeted therapy can be given as tablets or capsules.

This area of cancer treatment is changing rapidly, and it is likely that new gene changes and targeted therapy drugs will continue to be discovered. Talk to your medical oncologist about any clinical trials that may be suitable for you.

Cancer cells often become resistant to targeted therapy drugs over time. If the first-line treatment stops working, your oncologist may suggest trying another targeted therapy drug or another systemic treatment. This is known as second-line treatment.

Side effects of targeted therapy

Although targeted therapy drugs may cause less harm to healthy cells than chemotherapy, they can still have side effects. These side effects vary depending on the type of targeted therapy drugs used. Common side effects include a rash, fatigue, diarrhoea, nausea, body aches or swelling. Vomiting is a rare side effect.

In rare cases, targeted therapy may also cause pneumonitis (inflammation of the lung tissue), which can lead to breathing problems. It is important to report any new or worsening side effects to your treatment team. If left untreated, some side effects can become serious and may even be life-threatening. For a detailed list of side effects, visit visit NSW Government's eviQ.