Chemotherapy for lung cancer: What to know

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In the United States, lung cancer is the third most common type of cancer and is common in both men and women. In many cases of lung cancer, chemotherapy is part of the treatment.

Chemotherapy can have different goals depending on the nature of the disease it is treating. The goal may be either to treat the cancer by stopping or slowing the growth of cancer cells or to ease the symptoms of a person’s cancer.

SCLC

SCLC makes up about 15% of lung cancer cases, and chemotherapy is typically the primary treatment. This is because SCLC tends to spread more quickly and can require a treatment approach that works throughout the body. In roughly 70% of SCLC cases, the cancer has spread beyond the lungs by the time a doctor detects it.

A person with SCLC may undergo chemotherapy:

• Along with radiation therapy: Doctors refer to this approach as chemoradiation and will use it if cancer has not spread beyond the lungs.
• Before radiation therapy: Doctors will use this approach if a person cannot have both treatments at the same time.
• Along with immunotherapy: Immunotherapy is another systemic treatment that works throughout the body. A doctor may recommend it in cases in which the cancer has spread.
• After surgery (adjuvant chemotherapy): This is rarely an option for SCLC, but when it is, a doctor may use chemotherapy after surgery to clear any cancer cells that remain in the lungs.
• For more advanced cases: Doctors may use chemotherapy alone in these cases to improve a person’s symptoms and make them feel more comfortable.

NSCLC

NSCLC is the more common type, making up 80% of lung cancer cases. This type tends to spread more slowly, and the treatment plan depends on the stage of the disease.

Some people with NSCLC may not undergo chemotherapy at all. Instead, they may undergo surgery to remove cancer cells in the lungs.

However, a person with NSCLC may undergo chemotherapy:

• Before surgery (neoadjuvant chemotherapy): This shrinks cancer cells to improve the effectiveness of the surgery.
• After surgery: This helps clear any cancer cells that may remain.
• Along with radiation therapy: Doctors may reserve this combination of treatments for cases in which the cancer has advanced to nearby structures, such as the lymph nodes, or for people who cannot tolerate surgery.
• For advanced cases: Doctors may use chemotherapy alone or alongside immunotherapy techniques when the cancer has spread to other body parts.

Chemotherapy targets cells at various parts of the cell cycle, which is the process by which cells mature.

Cancer cells tend to go through cell cycles faster than typical cells and form new cells more rapidly. Through different mechanisms, depending on the drug, chemotherapy can interrupt this process and stop cancer cells from dividing and growing.

However, these drugs cannot differentiate between cancer cells and healthy cells, so chemotherapy can damage some healthy cells. To lessen side effects, it is important to find the balance between damaging the cancer cells enough to manage or cure the disease and minimizing the damage to healthy cells.

Typically, the treatment for lung cancer depends on the type. For SCLC, chemotherapy involves a combination of drugs, including:

• carboplatin and etoposide
• carboplatin and irinotecan
• cisplatin and etoposide

Chemotherapy for NSCLC will usually involve a combination of cisplatin or carboplatin with one of the following chemotherapy drugs:

• pemetrexed
• etoposide
• vinorelbine
• gemcitabine
• paclitaxel
• docetaxel

People will typically receive chemotherapy for lung cancer through either an injection, which takes a few minutes, or an infusion, which can take up to a few hours.

Healthcare professionals may use a central venous catheter, such as a peripherally inserted central catheter, to administer the chemotherapy. The catheter stays in a person’s arm throughout treatment so healthcare professionals do not need to use a new needle for each session.

A person may receive chemotherapy:

• in a doctor’s office or clinic
• in an outpatient infusion center
• in a hospital
• at home

Typically, a doctor will recommend that a person receive chemotherapy in cycles, each one followed by a period of rest to allow the person to recover. Cycles are 3–4 weeks long. Depending on the drug, a person may receive one dose at the start of the cycle or several doses spread out across the weeks.

However, the frequency of chemotherapy treatments may vary if a person is also receiving radiation treatment.

The number of cycles depends on the stage of a person’s cancer, as well as how they tolerate any side effects. For advanced SCLC cases, 4–6 cycles of chemotherapy treatment may be necessary.

Chemotherapy aims to interrupt the cell cycle of cancer cells to stop or manage the disease. However, it can also affect healthy cells in the body, leading to side effects.

Common side effects include:

• hair loss
• nausea
• vomiting
• loss of appetite
• constipation
• diarrhea
• mouth sores
• fatigue
• higher chance of infection
• easier bruising or bleeding
• memory and concentration problems

Along with physical side effects, a person may find the process emotionally challenging and, at times, may experience:

• anger
• frustration
• loneliness
• anxiety
• fear
• helplessness

Research suggests that 35–40% of people with cancer have a diagnosable mental health condition, such as depression or an anxiety disorder. If a person is finding it difficult to manage their mental health while undergoing chemotherapy, they may wish to contact their doctor and discuss support options.

The American Cancer Society offers resources on emotional, mental health, and mood changes that a person and their loved ones may experience during their cancer treatment.

The success rates depend on many factors, such as a person’s overall health status. In some cases, if the person is reasonably healthy, chemoradiation can successfully treat stage 3B NSCLC. However, this is less likely in the later stages of the disease.

Learn more about survival rates for both types of lung cancer.

A doctor may recommend that a person with lung cancer undergo chemotherapy to prevent or slow the growth of cancer cells. Chemotherapy can be beneficial in treating both SCLC and NSCLC.

The specific treatment course will likely depend on factors such as the type and stage of the disease, but treatment will usually consist of several cycles of chemotherapy. Chemotherapy can cause some challenging side effects, and a person should not hesitate to reach out for support during their treatment.