Targeted therapies are medications that block certain molecules that affect cancer’s ability to grow and spread. They are different from standard chemotherapy and have several potential benefits as a lung cancer treatment.
According to Dr. Timothy Byun, a hematologist and oncologist with the Center for Cancer Prevention and Treatment at St. Joseph Hospital in Orange County, CA, some Food and Drug Administration (FDA)-approved medications target specific genetic mutations that are responsible for lung cancer.
These drugs are often the therapy of choice for people with advanced-stage non-small cell lung cancer (NSCLC), said Dr. Byun. NSCLC accounts for
“In general, targeted therapies have higher response rates and [a] longer duration of benefit compared [with] chemotherapy in these patient subsets,” said Dr. Byun.
However, targeted therapies also have some potential drawbacks. Dr. Byun explained that, as with chemotherapy, a person’s cancer may develop a resistance to these medications. A person may also develop some side effects from taking these medications.
There are several different targeted therapies for people living with lung cancer. Individuals should talk with their doctor about which option is best for them.
This article discusses the most common mutations involved in lung cancer, the targeted therapies that treat them, and some potential side effects related to taking these medications.
Cancerous tumors need a steady blood supply to grow. Angiogenesis inhibitors are a type of long-term medication that targets the blood vessels supporting cancer cells. By blocking the growth of these blood vessels, this targeted treatment can slow or stop the growth of lung cancer.
A doctor is most likely to prescribe bevacizumab (Avastin) or ramucirumab (Cyramza) to treat lung cancer.
Side effects vary based on which part of the blood cells the medication targets. Some common side effects can
- fatigue
- high blood pressure
- diarrhea
- pain, swelling, tingling, numbness, or flushing in the hands or feet
- hair changes
- protein in the urine
- an increased risk of infections (due to low white blood cell counts)
- biochemical hypothyroidism
Serious side effects are rarer. These may include:
- holes (perforations) and fistulas in the gastrointestinal tract
- severe bleeding (hemorrhage)
- slow would healing
- heart failure
- stroke or heart attack (due to a blockage in the arteries)
- reversible posterior leukoencephalopathy syndrome (a brain condition)
Epidermal growth factor receptor (EGFR) is a protein on the outside of cells that controls their growth and division. EGFR genetic mutations can cause too much EGFR to be present in cells, which causes cancer to grow faster.
The overall prevalence of EGFR mutations is about
“For advanced-stage NSCLC with common EGFR mutations, EGFR targeted therapy such as osimertinib is the preferred first line of treatment,” said Dr. Byun.
EGFR inhibitors block the signals from EGFR to prevent the growth and division of cancer cells.
Some common EGFR inhibitors for lung cancer
- afatinib (Gilotrif)
- osimertinib (Tagrisso)
- erlotinib (Tarceva)
- dacomitinib (Vizimpro)
- gefitinib (Iressa)
Some common side effects of EGFR inhibitors can include:
- appetite suppression
- diarrhea
- skin problems, which can lead to skin infections
- mouth sores
These side effects can be severe enough that doctors recommend that people stop taking EGFR inhibitors.
“For example,” said Dr. Byun, “if a patient experiences a severe adverse reaction such as interstitial lung disease related to osimertinib, which occurs infrequently, then the medication is discontinued and the patient would be considered for chemotherapy.”
EGFR inhibitors that target cells with the T790M mutation
According to one
Osimertinib (Tagrisso) is a drug that targets cells with the T790M mutation. The side effects of this drug are similar to those of other EGFR inhibitors.
EGFR inhibitors used for squamous cell NSCLC
Necitumumab (Portrazza) is an EGFR inhibitor that mimics immune system proteins.
A doctor will give the medication intravenously and will often prescribe it with chemotherapy for people with advanced squamous cell NSCLC. It can cause similar side effects to those of other EGFR inhibitors.
EGFR inhibitors used for Exon 20 mutation
There is a rarer EGFR mutation known as Exon 20 which does not respond to many medications. However, researchers have developed some targeted drugs to target cancer resulting from this mutation as well.
These are medications are amivantamab (Rybrevant) and mobocertinib (Exkivity). Doctors will typically
Anaplastic lymphoma kinase (ALK) is a protein that
According to research, smoking may not be a major fact in the development of lung cancer related to an ALK mutation. ALK mutations are
ALK inhibitors are medications that target cancers with the ALK mutation. Certain people can use them after or instead of chemotherapy.
Some examples of these drugs
- alectinib (Alecensa)
- brigatinib (Alunbrig)
- crizotinib (Xalkori)
- ceritinib (Zykadia)
- lorlatinib (Lorbrena)
It is possible to experience side effects from taking this drug, including:
- vision changes
- fatigue
- constipation
- nausea and vomiting
- diarrhea
Some more severe and rare side effects include:
- heart rhythm problems
- liver or nerve damage
- swelling in the lungs or throughout the body
The American Cancer Society estimates that
According to one
If a doctor identifies a ROS1 mutation, they may
- lorlatinib (Lorbrena)
- crizotinib (Xalkori)
- ceritinib (Zykadia)
- entrectinib (Rozlytrek)
People can use these medications instead of chemotherapy or when chemotherapy or other therapies stop working. Some potential side effects may include:
- constipation
- dizziness
- diarrhea
- vision problems
- fatigue
More severe side effects may include:
- liver or nerve damage
- swelling in the lungs or elsewhere in the body
- heart problems
About
Medications to target RET genes include selpercatinib (Retevmo) and pralsetinib (Gavreto).
Some common side effects can
- rash
- high blood pressure
- dry mouth
- diarrhea or constipation
- joint pain
- hand and feet swelling
- elevated blood sugar levels
- muscle pain
- feeling tired
- changes in some blood test results
- low blood counts
More severe and rare side effects may include:
- problems with wound healing
- bleeding
- lung or liver damage
- heart rhythm changes
- allergic reactions
According to one 2015 study, changes in the mesenchymal-epithelial transition (MET) gene are present in
Capmatinib (Tabrecta) is the first FDA-approved MET-targeting medication for treating metastatic NSCLC. Another
Researchers are
Some potential side effects of these drugs may
- lack of appetite
- swelling in the hands or feet
- constipation
- nausea
- vomiting
- weakness or tiredness
- diarrhea
- changes in some blood test results
- sun sensitivity
Rarely, these drugs can cause liver damage and swelling or scarring in the lungs.
Doctors typically prescribe two medications for this mutation in people with advanced lung cancer: larotrectinib (Vitrakvi) and entrectinib (Rozlytrek). Both are typically given when the cancer does not respond to other treatments.
Some potential side effects
- diarrhea
- dizziness
- fatigue
- constipation
- vomiting
- weight gain
- nausea
Some other, less common side effects include:
- confusion
- heart problems
- irregular liver test results
According to research,
The two targeted medications doctors commonly use to treat lung cancer with a BRAF mutation are dabrafenib (Tafinlar) and trametinib (Mekinist). Dabrafenib attacks BRAF proteins directly. Trametinib attacks related MEK proteins. Doctors may use these medications together to treat metastatic NSCLC in some cases.
Some potential side effects
- skin thickening, rash, or itching
- sensitivity to the sun
- headache
- fever
- joint pain
- fatigue
- hair loss
- nausea
- diarrhea
Rarer side effects include:
- bleeding
- heart rhythm problems
- liver or kidney problems
- other lung problems
- serious llergic reaction
- severe skin or eye problems
- high blood sugar
Approximately
People with this mutation are resistant to many other targeted medications. Doctors commonly use Sotorasib (Lumakras) to treat cancer with this type of mutation. The medication works by attaching to the KRAS G12C protein and preventing the cancer cell from growing.
The side effects can include:
- diarrhea
- joint or muscle pain
- nausea
- fatigue or weakness
- cough
- Low white or red blood cell counts
Rarer serious side effects can include:
- liver damage
- swelling or swelling in the lungs
- difficulty breathing
A number of different drugs provide targeted treatment for many people with lung cancer.
These medications work by honing in on certain mutations in genes involved in lung cancer and stopping the reproduction, growth, and spread of cancer cells.
People may use targeted therapies with, instead of, or following other cancer therapies, including chemotherapy.
What is the most effective treatment for non-small cell lung cancer?
There is no one most effective treatment for any person. This depends on the stage of the disease and how it is progressing. In stages 0-1, surgery may be the only treatment. In stage 2, a person may need surgery followed by chemotherapy. When there are gene mutations present, doctors will also use targeted therapy. In stage 3 and beyond, doctors may prescribe radiation or radiation along with the other treatments. The further the disease develops, the harder it is to cure.
Learn more about treatment for NSCLC.
How long can you live with non-small cell lung cancer?
Overall, about