Drug therapies for lung cancer

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.

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. 

Anaemia – A low red blood cell count is called anaemia. This can make you feel tired, breathless or dizzy. Your treatment team will monitor your red blood cell levels and suggest treatment if necessary. 

Risk of infections – Chemotherapy drugs can lower the number of white blood cells that fight infections caused by bacteria. This means if you get an infection caused by a virus, such as a cold, flu or COVID-19, the risk of getting a bacterial infection is further increased. Talk to your doctor about being vaccinated against flu and COVID-19. Keeping your hands and mouth clean and social distancing can also help prevent the risk of infection. If you feel unwell or have a temperature above 38°C, call your doctor immediately or go to the hospital emergency department.

Mouth ulcers – Some chemotherapy drugs cause mouth sores, ulcers and thickened saliva, making swallowing difficult. Your treatment team will explain how to prevent these issues and take care of your mouth.

Hair loss – You may lose hair from your head, chest and other areas, depending on the chemotherapy drugs you receive. The hair will grow back after treatment is completed, but the colour and texture may change.

Nausea, vomiting or constipation – You will usually be prescribed anti-nausea medicine with your chemotherapy drugs, but some people still feel sick (nauseous) or vomit. Constipation is also a common side effect of some types of anti-nausea medicines. Let your treatment team know if you have these side effects, as they may be able to give you extra medicines.

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 eviq.org.au.

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 (see pages 20–21) 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 eviq.org.au.

Palliative and supportive care

If the cancer is advanced when it is first diagnosed or comes back after treatment (recurrence), your doctor will discuss palliative treatment for any symptoms caused by the cancer. This is also known as supportive care. They may refer you to a palliative care specialist. 

Palliative treatment aims to manage symptoms without trying to cure the disease. It can be used at any stage of advanced lung cancer to improve quality of life and does not mean giving up hope. In fact, palliative treatment can help some people with advanced lung cancer to live well and with few symptoms for many months or years. 

Ways that symptoms may be relieved include:

• having palliative drug therapies (chemotherapy, immunotherapy and 
  targeted therapy), radiation therapy and surgery to slow the spread of 
  cancer and control symptoms such as pain or breathlessness
• draining any fluid to help prevent it building up again. 

Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, spiritual and social needs and those of your family or carer.