Surgery
Doctors may recommend surgery if the cancer hasn’t spread beyond nearby lymph nodes.
There are different types, including:
- Lobectomy Removal of one of the lobes of the lung
- Wedge or Segment Removal Removal of only a small part of the lung
- Pneumonectomy Removal of the entire lung
Sometimes surgeons use a method that involves only small incisions, known as video-assisted thoracoscopic surgery (VATS).
Doctors insert a thoracoscope into the chest, then remove a lung lobe through the scope.
Radiofrequency Ablation
Radiofrequency ablation (RFA) uses high-energy radio waves to heat and destroy tumors.
This procedure may be an option for people with NSCLC who have small tumors that are located near the outer edge of the lungs. This is only used for patients who are not good candidates for surgery because of health concerns.
RFA is usually performed as an outpatient procedure, with local anesthesia.
Chemotherapy
Chemotherapy (aka chemo) uses drugs to kill cancer cells.
Doctors usually administer it through an intravenous (IV) infusion, but some chemo drugs also come in pill form.
Patients sometimes receive chemo before or after surgery, or at both times, or simultaneously with radiation therapy.
Some commonly used chemo drugs for NSCLC are:
- cisplatin (Platinol)
- carboplatin (Paraplatin)
- docetaxel (Taxotere)
- gemcitabine (Gemzar)
- paclitaxel (Taxol)
- Protein-bound paclitaxel (Abraxane)
- irinotecan (Camptosar)
- vinorelbine (Navelbine)
- pemetrexed (Alimta)
Chemotherapy can cause side effects, such as:
- Hair loss
- Nausea
- Vomiting
- Loss of appetite
- Mouth sores
- Diarrhea
- Constipation
- Fatigue
- Easy bruising or bleeding
- Increased risk of infections
Radiation
Radiation therapy uses high-energy rays or particles to kill cancer cells.
Patients might receive this therapy before or after surgery, or both, or while they’re getting chemo.
Sometimes doctors use it to shrink tumors that have spread to other areas in the body.
The two kinds of radiation therapy for NSCLC are:
- External Beam Radiation This uses a machine outside the body to deliver radiation to the cancer.
- Brachytherapy Doctors place small amounts of radioactive material directly into the cancer or the airway next to the cancer.
Radiation can cause side effects, such as:
- Fatigue
- Nausea
- Vomiting
- Loss of appetite
- Weight loss
- Skin changes, such as blistering or peeling
- Hair loss on treated areas
Targeted Treatments
Targeted therapy works by attaching to or blocking specific targets unique to a cancer cell.
Targeted medication can be used alone or in combination with chemo, and can be given as a pill or through IV injection.
Some common targeted treatments for NSCLC include:
- Angiogenesis Inhibitors These medicines block new blood vessel growth. They include bevacizumab (Avastin) and ramucirumab (Cyramza).
- Epidermal Growth Factor Receptor (EGFR) Inhibitors EGFR is a protein on the surface of cancer cells that helps them grow. EGFR is mutated in a subset of lung cancer patients so that the “on” growth signal is always present. Drugs that block the signal from EGFR include afatinib (Gilotrif), gefitinib (Iressa), osimertinib (Tagrisso), and dacomitinib (Vizimpr).
- ALK Inhibitors ALK is a gene that is sometimes abnormal (mutated, or more accurately “rearranged”) in people with NSCLC. Similar to EGFR mutations, these changes result in the “on” growth switch to always be on. Medicines that target the ALK mutation include crizotinib (Xalkor), ceritinib (Zykadia), alectinib (Alecensa), brigatinib (Alunbrig), and lorlatinib (Lorbrena).
- BRAF Inhibitors In some cases of NSCLC, the cells have mutations in the BRAF gene, again, telling the cells to grow in an uncontrolled way. Drugs that block this mutation include dabrafenib (Tafinlar) and trametinib (Mekinist).
- New Developments More recent advances include drugs to treat HER2, KRAS, ROS1, NTRK, and MET mutations, as well as RET rearrangements.
Targeted medicines often cause less severe side effects than chemotherapy, but they can still lead to problems, such as:
- Fatigue
- Bleeding
- Headaches
- Mouth sores
- Loss of appetite
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Skin problems
- Joint pain
- Vision changes
- High blood pressure
- Increased risk of infections
Immunotherapy
Immunotherapy stimulates the body’s own immune system to kill cancer cells.
It is now incorporated in the first treatment of most patients with lung cancer, other than those who have a specific mutation that can be treated with a targeted therapy.
Immunotherapy medicines are given as an infusion.
Examples of immunotherapy drugs include used for NSCLC include:
- nivolumab (Opdivo)
- ipilimumab (Yervoy)
- cemiplimab (Libtayo)
- pembrolizumab (Keytruda)
- atezolizumab (Tecentriq)
- durvalumab (Imfinzi)
Side effects might include:
- Fatigue
- Cough
- Nausea
- Itching
- Rash
- Diarrhea
- Constipation
- Loss of appetite
- Joint pain
In rare cases, the use of immunotherapy can cause the immune system to attack other parts of the body, which can lead to serious or life-threatening problems in certain organs.
Laser Therapy
Rarely, lasers may be used to treat small tumors in the linings of the airways.
They can also open up airways that are blocked by larger tumors.
Doctors pass a bronchoscope down the throat and aim the laser beam at the tumor to burn it away.
This procedure is typically done under general anesthesia.
Clinical Trials
Patients with NSCLC may want to consider participating in a clinical trial.
These studies take place in various locations around the country. Clinical trials offer access to novel investigational therapies that aren’t yet available to the general public.
More information on clinical trials is available on the National Cancer Institute’s Clinical Trials Information for Patients and Caregivers page.
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