Chemotherapy is a drug or a combination of drugs that travel throughout the body to kill cancer cells wherever they are. It is the primary treatment for small cell lung cancer. For non-small cell lung cancer, your doctor may recommend chemotherapy either before or after surgery.
Our medical oncologists use the most sophisticated approaches to treating lung cancer, including clinical trials of new therapies and drug combinations.
Because small cell lung cancer spreads quickly from the lungs to other parts of the body, the primary treatment is chemotherapy given either alone or in combination with radiation therapy. The approach your MSK doctors recommend will depend on the stage of your disease.
- People with limited-stage small cell lung cancer receive a combination of chemotherapy and radiation therapy at the same time to shrink the tumor.
- People with extensive-stage cancer typically receive chemotherapy only. This is because radiation therapy is highly targeted and is not effective when the cancer has spread from the lung in which it began to other parts of the body. Radiation therapy may be used in some patients to help improve symptoms or to prevent the cancer from spreading to the brain.
Initial chemotherapy for almost all patients with small cell lung cancer includes the combination of the drug etoposide with a platinum agent (either cisplatin or carboplatin).
Currently, there is only one approved chemotherapy drug for patients whose disease continues to grow or comes back after completion of this initial treatment — which unfortunately happens to all patients with extensive-stage small cell lung cancer and the majority of patients with limited-stage small cell lung cancer. We are constantly in pursuit of new therapies for patients whose cancer has recurred following standard treatment.
New Drug Approaches
For many patients, the best treatment strategy is to enroll in a clinical trial that tests new drugs. These drugs can be tested either alone or in combination with more established treatments.
We are testing several new treatments for small cell lung cancer. These include drugs that are targeted against cancer stem cells — which are thought to give rise to other cells in a tumor and be required for the tumor to spread — and drugs that target growth pathways normally present only in the developing embryo but that are reactivated in small cell lung cancer.
In addition, we have begun testing drugs that stimulate patients’ own immune systems to recognize and attack small cell lung cancer. All of these approaches are experimental but have shown promise in the laboratory.
We are also conducting studies to investigate the molecular factors that lead to small cell lung cancer. Understanding these factors holds hope for developing targeted therapies — a new class of drugs that can stop the progression of cancer by binding to specific molecular targets.
Even tumors that are completely removed during surgery or destroyed by radiation therapy can return if microscopic cancer cells have traveled from the primary tumor to other parts of the body. Our doctors give chemotherapy to many patients with non-small cell lung cancer, either before or after surgery.
Our medical oncologists work closely with your surgeon to determine whether adding chemotherapy to your treatment plan either before or after surgery could give you a better outcome.
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. Our doctors also consider the results from the genetic testing of your tumor, which may indicate that one chemotherapy regimen will work better than another.
Chemotherapy before Surgery (Neoadjuvant Chemotherapy)
The first place where cancer cells spread from the lungs is often 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.
MSK-led studies have shown that giving chemotherapy before surgery can improve cure rates in patients with non-small cell lung cancer that has spread to the lymph nodes. This technique, called neoadjuvant chemotherapy, involves giving chemotherapy for several months prior to surgery. In some cases, cancer cells in the lymph nodes can be completely eliminated before surgery.
Because of this success in some patients, our doctors are continuing to test this approach using newer drug therapies. We have also begun offering neoadjuvant chemotherapy 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, called adjuvant chemotherapy. Whether your doctor recommends this technique depends on a variety of factors, including the size of your tumor. Adjuvant chemotherapy is often prescribed when the cancer cells have spread to the lymph nodes. Traditional adjuvant chemotherapy can help you to live longer and improves your chance for a cure.
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 MSK, 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 testing for genetic mutations that we perform for almost all non-small cell lung cancer patients. Our goal is to individualize 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 their tumor. These include drugs that are specifically toxic to the cancer cells and agents that stimulate the immune system to fight cancer.
Lastly, we’re 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 MSK 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.