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Non-Small-Cell Lung Cancer (cont.)

Medical Treatment

Patient Comments

The 3 major therapies used in NSCLC are surgery, chemotherapy, and radiation therapy. A newer fourth therapy, laser therapy, is becoming more widely used.

  • Surgery: The tumor is removed through an incision in the skin and muscle.
  • Chemotherapy: Strong chemicals and drugs are taken internally, either by mouth or through a vein into the bloodstream, to kill tumor cells.
  • Radiation therapy: A powerful radiation beam is pointed at the tumor (external beam) or a radiation source is placed within the body next to the tumor (internal beam). The radiation kills the tumor cells.
  • Laser therapy: A narrow beam of intense light called a laser is used to kill tumor cells.

Each person with NSCLC should be offered a customized treatment regimen, which should consist of some combination of these therapies depending on disease stage and location.

After the staging evaluation, a decision is made whether the tumor is operable. Operable (or resectable) tumors are those that can be removed completely or almost completely by surgery. Generally, only stage I and some stage II and III tumors can be removed by surgery. Sometimes, people with stage III or IV inoperable disease undergo surgery, but this is usually performed to remove enough of the tumor to relieve symptoms such as breathing problems or severe pain. Surgery does not cure people with stage IV or most stage III diseases. For more information see Surgery.

Chemotherapy

NSCLC is only moderately sensitive to chemotherapy. Chemotherapy alone does not have the potential to cure people with NSCLC. When the goal is cure, chemotherapy is given in combination with surgery or radiation therapy. Chemotherapy alone is given only to people who cannot undergo surgery or radiation therapy or, in some cases, people whose disease has relapsed after surgery. When given in combination with surgery, the chemotherapy is usually given after surgery (adjuvant chemotherapy). Adjuvant chemotherapy is recommended to treat cancer in stages I-III after surgery has been performed to remove the cancer. Before beginning treatment, the patient undergoes testing to determine the extent of her disease. In general, chemotherapy is given in cycles. Treatment usually lasts a few days and is then followed by a recovery period of a few weeks. When side effects have subsided and blood cell counts have started to return to normal, the next cycle begins. Usually, chemotherapy is given in regimens of 2 or 4 cycles. After these cycles are over, the patient undergoes repeat CT scans and other tests to see what effect the chemotherapy has had on the tumor.

Radiation therapy

Radiation therapy may be given in combination with surgery or chemotherapy or alone. Generally, radiation therapy is given alone only for persons who are not candidates for surgery.

Medications

Inoperable NSCLC is treated with chemotherapy or a combination of chemotherapy and radiation therapy. Chemotherapy usually requires other supportive medications to prevent or treat side effects such as nausea and vomiting, anemia (low red blood cell count), bleeding (from low platelet count), and neutropenia (low numbers of infection-fighting types of white blood cells called neutrophils). Because neutropenia increases the risk of infections, antibiotics may also be given. Growth factors are often given to promote the production of red and white blood cells and platelets. The agents most widely used to prevent or treat nausea and vomiting are corticosteroids (dexamethasone [Decadron]) and the serotonin receptor antagonists, which include ondansetron (Zofran), granisetron (Kytril), and dolasetron (Anzemet). For more information, see Understanding Lung Cancer Medications.

The chemotherapy agents that are currently used to treat NSCLC include the following:

  • Cisplatin (Platinol): This agent damages the DNA of the tumor cells. It can also damage healthy cells, which accounts for some of the side effects such as hair loss and nausea. This drug can be harmful to the kidneys and must be given with extreme caution to people with kidney problems. It also can damage the ears and diminish hearing.
  • Carboplatin (Paraplatin): This drug is similar to cisplatin but generally causes fewer side effects.
  • Vinorelbine (Navelbine): This agent stops tumor cell growth by interfering with cell division.
  • Paclitaxel (Taxol): This drug also interferes with cell division.
  • Gemcitabine (Gemzar): This drug interferes with formation of DNA in cells so they cannot reproduce.
  • Docetaxel (Taxotere): This agent prevents cell division by interfering with the cell’s preparations to divide.
  • Premetrexed disodium (Altima): This chemotherapy agent disrupts metabolic processes essential for cell production.
  • Gefitinib (Iressa), erlotinib (Tarceva), and Afatinib (Gilotrif): These are new targeted drugs used to treat advanced NSCLC that is resistant to more conventional chemotherapy agents. These drugs are referred to as tyrosine kinase inhibitors. They inhibit the activity of a substance called epidermal growth factor receptor tyrosine kinase, which is located on the surface of cells and is needed for growth.

Crizotinib and Ceritinib are new oral targeted agents that can help to treat NSCLC when mutations in other genes in the cancer cells are detected.

Medically Reviewed by a Doctor on 9/11/2014
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