Chemotherapy and Other Systemic Therapies for Lung Cancer

MSK is a leader in developing new systemic therapies for treating lung cancer.
Clinical nurse Megan McCue is at the David H. Koch Center for Cancer Care.
Clinical nurse Megan McCue is at the David H. Koch Center for Cancer Care.
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Overview of lung cancer chemotherapy and other systemic therapies

Lung cancer chemotherapy (chemo), targeted therapies, and immunotherapy are called systemic therapies. Treatments are given by mouth, intravenous (IV) infusion, or injection (shot). They spread throughout the body to treat cancer.

Your care team may recommend systemic therapies to treat lung cancer.

You may have neoadjuvant (NEE-oh-A-joo-vant) therapy, which is treatment you get  before  lung cancer surgery. Neoadjuvant therapy shrinks tumors so they’re easier to remove during surgery. 

You may have adjuvant (A-joo-vunt) therapy, which is treatment you get  after  lung cancer surgery. It’s used to kill any cancer cells that may be left. Adjuvant therapy can lower the risk of lung cancer coming back or spreading.

Some people may have both neoadjuvant and adjuvant therapy. Your care team will talk with you about whether that’s right for you.

Your treatment plan is based on your overall health, the cancer’s stage and size, and the tumor’s genetics. 

MSK’s medical oncologists (cancer doctors) use the latest methods to treat lung cancers. This includes research studies, also known as clinical trials, of new therapies and drug combinations. 

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Chemotherapy for lung cancer

What is chemotherapy?

Chemotherapy (chemo) is a treatment that uses strong medicine to stop or slow cancer cells from growing. Chemo puts medicine that targets cancer cells into your vein through an IV. The medicines travel in your bloodstream to kill cancer cells in the body. 

There are many kinds of chemo medicines for lung cancer. Your care team will talk with you about the best options.

These medicines in general fight lung cancers by affecting how cancer cells grow and spread.

There are many types of chemo medicines, and they do not work in the same way. 

They have different doses and schedules. Some are used alone, while others are used along with other medicines. There also are differences in how well chemo medicines work.  

Chemotherapy medicines and regimens

If chemotherapy is a part of your treatment, your medical oncologist (cancer doctor) will recommend a chemotherapy plan. It’s also called a chemotherapy regimen (REH-jih-men).

This treatment plan tells you important details, including:

  • Which medicines you’ll get.
  • The order in which you’ll get them.
  • The dose (amount) of each drug.
  • How often and how long you will need chemotherapy.
  • Supportive medicine, such as drugs for nausea or pain, to help you tolerate treatment better. 
Your care team will make a treatment plan. It’s based on the type of cancer you have and how far the cancer has spread:
Chemotherapy for small cell lung cancer
Small cell lung cancer spreads fast from the lungs. For most people, chemotherapy is the primary (first) treatment. It’s often given with immunotherapy. Your doctor may talk with you about radiation therapy. 
Chemotherapy for small cell lung cancer
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Chemotherapy for non-small cell lung cancer
Chemotherapy for small cell lung cancer
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Chemotherapy for non-small cell lung cancer
Chemotherapy for non-small cell lung cancer
Non-small cell lung cancer tumors can be removed with surgery. We give chemotherapy before or after surgery. This is to kill any cancer cells left after surgery. Tumors can come back after treatment. 
Chemotherapy for non-small cell lung cancer

Surgery may be a treatment for stage 1, 2, or 3 non-small cell lung cancer tumors. We may give chemotherapy with or without immunotherapy, before or after surgery.

Our medical oncologists (cancer doctors) work closely with other experts to design the best treatment plan. They include your surgeon, radiation oncologist, and pathologist. 

Together, they’ll decide if adding chemotherapy is right for you. You may have it with or without immunotherapy, before or after surgery. 

Tumors already may have spread when you first learn you have non-small cell lung cancer. 

The cancer may have spread locally in the lung. Or, your surgeon may feel they cannot safely remove the cancer. If so, we may recommend chemotherapy along with radiation therapy. You also may have immunotherapy.

Tumors can come back even if they were removed during surgery or killed by radiation therapy. This happens if very tiny cancer cells travel from the primary tumor to other areas.

In some cases, the cancer spreads to other areas, such as the other lung or other parts of your body. We may recommend chemotherapy alone, or with immunotherapy.

MSK will test your tumor to get information about any genetic changes (mutations or variants). Genomic testing tells us which mutations caused the lung cancer and makes it grow and spread.  

There may be a genetic change in the tumor that we can target with a treatment. This method is called targeted therapy. It’s a personal treatment just for the type of cancer you have. Targeted therapies are also called personal medicine, precision medicine, or precision oncology. 
Chemotherapy for non-small cell lung cancer

Surgery may be a treatment for stage 1, 2, or 3 non-small cell lung cancer tumors. We may give chemotherapy with or without immunotherapy, before or after surgery.

Our medical oncologists (cancer doctors) work closely with other experts to design the best treatment plan. They include your surgeon, radiation oncologist, and pathologist. 

Together, they’ll decide if adding chemotherapy is right for you. You may have it with or without immunotherapy, before or after surgery. 

Tumors already may have spread when you first learn you have non-small cell lung cancer. 

The cancer may have spread locally in the lung. Or, your surgeon may feel they cannot safely remove the cancer. If so, we may recommend chemotherapy along with radiation therapy. You also may have immunotherapy.

Tumors can come back even if they were removed during surgery or killed by radiation therapy. This happens if very tiny cancer cells travel from the primary tumor to other areas.

In some cases, the cancer spreads to other areas, such as the other lung or other parts of your body. We may recommend chemotherapy alone, or with immunotherapy.

MSK will test your tumor to get information about any genetic changes (mutations or variants). Genomic testing tells us which mutations caused the lung cancer and makes it grow and spread.  

There may be a genetic change in the tumor that we can target with a treatment. This method is called targeted therapy. It’s a personal treatment just for the type of cancer you have. Targeted therapies are also called personal medicine, precision medicine, or precision oncology. 

Chemotherapy with radiation (chemoradiotherapy)

Some non-small cell lung cancers are in the chest only, but surgery cannot remove them. We may treat the tumors with chemotherapy, along with radiation. You also may have immunotherapy.

Radiation can work very well on lung cancer in the primary area in the chest. Chemotherapy helps the radiation work better. It also can treat very tiny cancer cells that may have spread outside the chest. 

THE MSK DIFFERENCE

MSK is a leading national researcher on neoadjuvant chemotherapy. Our research shows chemo before surgery doubled the cure rate for stage 3 non-small cell lung cancer that spread to lymph nodes. It also cured some lung cancers that cannot be cured with surgery alone. 

Are there side effects to lung cancer chemotherapy?

Chemotherapy most often works by attacking cells that divide very fast. Its goal is to kill cancer cells. But it also harms healthy cells that divide fast. That includes the cells that make your hair grow.

Hair loss can be a side effect of some, but not all, chemotherapy for lung cancers. 

Whether you have side effects from lung cancer chemotherapy depends on your treatment plan.

We have more information on  managing the side effects of chemo.

We have ways to help  manage nausea  during chemotherapy. Our supportive care team will  manage the symptoms and side effects of cancer treatment. 

Rehabilitation medicine doctor Jesuel Padro-Guzman
Chemotherapy-Induced Peripheral Neuropathy (CIPN) may start during chemotherapy or months after treatment ends.
Rehabilitation medicine doctor Jesuel Padro-Guzman cares for many people with CIPN, a common side effect of chemotherapy. This nerve problem can cause weakness, numbness, pain, and tingling. It’s sometimes called chemo feet and chemo hands.
Learn more

Targeted therapy for lung cancer

What is targeted therapy?

Targeted therapies are cancer treatments that target a tumor’s gene changes (mutations or variants). It’s a personal treatment plan just for the type of cancer you have. These medicines most often are given by mouth in pill form or through an IV into your vein.

Targeted therapies also are called personal medicine, precision medicine, or precision oncology.

Lung cancer research is finding more drugs that work by targeting certain molecules that make lung cancer cells grow and divide. Targeted drugs attack the mutated proteins in cancer cells. They slow or stop their growth. Most healthy cells are not affected. 

What is genomic testing for targeted therapy?

Genomic testing tells us which mutations caused the lung cancer. This information lets us target those genes for treatment.  

At MSK, genetic testing is a routine part of the diagnosis  process for people who have non-small cell lung cancer. This testing can be done on tumor tissue. We also can test your blood samples we collect during a visit.

Gene mutations that can be treated with targeted therapies are very common in lung cancer. For example, half of all lung adenocarcinomas (A-deh-noh-KAR-sih-NOH-muhs) are linked to gene mutations. We target those mutations to treat the lung adenocarcinoma. 

Some chemotherapy and immunotherapy work better or worse on tumors that have certain mutations. For lung cancer, targeted therapies often are the best treatment option. 

Targeted therapy drugs target the most common lung cancer gene mutations, such as: 

  • EGFR
  • KRAS
  • ALK
  • MET
  • RET
  • ROS1
  • BRAF
  • HER2
  • NTRK 

Are there side effects to lung cancer targeted therapies?

Targeted therapies in general do not cause hair loss. Targeted therapies also are much less likely to have other  common side effects of chemotherapy, such as low blood counts.

Common side effects of targeted therapy can include:

  • Fatigue (feeling tired)
  • Gastrointestinal (stomach and intestinal) problems. They include nausea (feeling like throwing up) and diarrhea (loose poop).

Some targeted therapy drugs have other side effects because they target proteins also found in normal cells. 

Your care team will talk with you about what side effects to expect. They have a lot of experience in managing side effects. They offer treatments that can help you feel better. Examples are drugs that help with nausea, and  integrative medicine  treatments. 

Thoracic medical oncologist Dr. Juliana Eng treats people with lung cancer at MSK Commack.
Lung cancer can be very scary. I just want patients to know it's not as scary anymore because we have such better treatments. The outcomes are better, the side effects are better.
Thoracic medical oncologist Dr. Juliana Eng treats people with lung cancer at MSK Commack.
Watch Dr. Eng

Immunotherapy for lung cancer

What is immunotherapy?

Immunotherapy is a form of cancer treatment. It boosts your immune system’s natural ability to fight cancer. Your immune system attacks cancer cells, much the same way it attacks bacteria or viruses.  

MSK is always working to make cancer immunotherapy better. There are now a few immunotherapy drugs approved for treatment of non-small cell lung cancer. These drugs release a brake on the immune system so it can start a stronger attack against cancer.  

We may use these drugs alone or with chemotherapy. Immunotherapy is given through an IV during a visit. 

There’s a laboratory test that looks at whether a protein called PD-L1 is on a lung cancer cell. This test can help tell us if immunotherapy drugs may be a good treatment for you. 

You may be able to join immunotherapy research studies, also known as clinical trials. Some of these trials may offer early access to promising immunotherapy treatments.

Are there side effects to immunotherapy?

The most common side effects are caused by the immune system having a strong reaction to normal tissues. Side effects often are related to inflammation, and can include: 

  • Skin problems, such as a rash or itching.
  • Chills, fatigue, and other flu-like symptoms.
  • Gastrointestinal problems, such as diarrhea.
  • Pain from joint inflammation (swelling). 

We can safely manage most side effects if we treat them early. Sometimes, side effects can cause harm. This can happen if they’re not treated fast and they involve vital (very important) organs. 

MSK doctors are experts in caring for people who have side effects from immunotherapy. 

Innovations at MSK

Our experts are always finding new ways to treat lung cancer and manage side effects. Explore lung cancer news from MSK.

 

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Last updated June 11, 2025
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