Even tumors that are completely removed by surgery or destroyed by radiation therapy can return if microscopic cancer cells have traveled from the primary tumor to other parts of the body. Chemotherapy is a drug or combination of drugs that travels throughout the body to kill cancer cells wherever they might be. Doctors at Memorial Sloan Kettering give chemotherapy to many patients with non-small cell lung cancer, either before or after surgery.
Which drugs you receive depends on what kind of non-small cell lung cancer you have — adenocarcinoma, squamous cell carcinoma, or large cell lung cancer. At Memorial Sloan Kettering, medical oncologists also consider the results from the genetic testing of your tumor, which may indicate that one chemotherapy regimen will work better than another.
Because there are so many new treatments being tested at Memorial Sloan Kettering, our surgeons work closely with our medical oncologists to determine when, and whether, to give chemotherapy.
Chemotherapy before Surgery (Neoadjuvant Chemotherapy)
The first place where cancer cells spread from a primary tumor in the lungs is often to the lymph nodes (also called lymph glands). This is because the lymph nodes act as a filter, trapping cancer cells as they travel out of the lungs.
Doctors at Memorial Sloan Kettering were among the first to show that giving chemotherapy before surgery can improve cure rates in patients with non-small cell lung cancer that has spread to lymph nodes. This technique, called neoadjuvant chemotherapy, involves giving the patient several months of chemotherapy prior to surgery. In some cases, cancer cells in the lymph nodes can be completely eliminated before surgery.
This approach has doubled the cure rate in patients with stage III non-small cell lung cancer, and has cured patients with some forms of lung cancer who would not have been cured by surgery alone.
Because of this success in some patients, doctors at Memorial Sloan Kettering are now testing neoadjuvant therapy that uses new drugs and targeted therapies. We have also begun offering this approach to patients with larger tumors that have not yet spread to the lymph nodes but have a high risk of returning despite successful surgery.
Chemotherapy after Surgery (Adjuvant Chemotherapy)
Another approach is to give chemotherapy after surgery; this is called adjuvant chemotherapy. Whether your doctor recommends adjuvant chemotherapy depends on a variety of factors, including the size of the tumor. Adjuvant chemotherapy is often prescribed when the cancer cells have spread to lymph nodes. Traditional adjuvant chemotherapy can help you to live longer and improves your chance for a cure.
Memorial Sloan Kettering is working to develop more-effective adjuvant treatments that have fewer side effects. We are conducting clinical trials investigating vaccines that could harness a patient’s immune system to fight cancer, as well as drugs that target molecules unique to cancer cells.
Clinical Trials of New Chemotherapy Drugs
For many patients, the best strategy may be to enroll in a clinical trial that tests new drugs. These drugs can be tested either alone or in combination with more established treatments.
Treatment of lung cancer has become increasingly tailored to the histology (appearance under the microscope) and molecular profile of each patient’s tumor. At Memorial Sloan Kettering, our goal is to use this information to identify the best treatment plan for you.
Many of our current clinical trials are designed around the mutational testing that we perform on almost all non-small cell lung cancer patients. Our goal is to individualize the treatment to be as specific and as targeted as possible.
We also have clinical trials testing new approaches to lung cancer treatment that are available to patients without specific mutations in the tumor. These include drugs that are specifically toxic to the cancer cells agents that stimulate the immune system to fight cancer.
Memorial Sloan Kettering is also conducting early-stage (phase I) trials exploring how cutting-edge scientific discoveries could translate into new drugs for the treatment of cancer. Typically patients who are considered for these trials have already tried a number of standard treatments that did not lead to improvements in their condition.
By choosing Memorial Sloan Kettering for your care, you may gain access to new treatments that are not widely available elsewhere. Participating in a clinical trial is one way for you to make a valuable contribution toward progress against lung cancer.