Chemotherapy and Other Systemic Therapies for Lung 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. 

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.  

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. 

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. 

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. 

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. 

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 

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. 

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.

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.