When lung cancer has spread outside the lung and to other parts of the body, the goal of treatment is to control the cancer, to slow down its spread and to manage any symptoms. Because the symptoms of lung cancer are often vague in its early stages, some people find that the cancer is advanced when it is first diagnosed.
You may have the same treatments used for treating early lung cancer, such as radiotherapy and chemotherapy, or targeted therapy and immunotherapy. Some of these treatments may be part of palliative treatment. Specific treatments to manage symptoms that make breathing difficult are covered in the managing symptoms section.
New types of drugs known as targeted therapy or personalised medicine target specific mutations within cancer cells and often work by blocking cell growth. Targeted therapy drugs are generally used for advanced NSCLC (stage IV) or if the cancer has come back (recurred). Clinical trials are studying whether targeted therapy is helpful in treating small cell lung cancer.
Different types of targeted therapy drugs are used for advanced lung cancer (see below).
Cancer cells often become resistant to targeted therapy drugs over time. If this first-line treatment stops working, your doctor will suggest trying another targeted therapy drug. This is known as second-line treatment.
Targeted therapy is available for two common gene mutations associated with lung cancer: epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations.
Some targeted therapy drugs approved for lung cancer include:
- EGFR – erlotinib, afatinib and gefitinib
- ALK – crizotinib, ceritinib and alectinib.
Some targeted therapy drugs may be available only through a clinical trial. This area of science is changing rapidly, and it’s likely that new mutations and targeted therapy drugs will continue to be discovered. Talk to your doctor for more information about new drug trials.
Types of targeted therapy
In Australia, there are currently two main types of targeted therapy used to treat lung cancer: monoclonal antibodies and small molecule inhibitors.
- stop the cancer developing new blood vessels and growing
- usually given intravenously
- the drug bevacizumab is given with chemotherapy every 3 weeks
Small molecule inhibitors
- stop cancer cells growing and multiplying
- usually given as tablets
- the drugs erlotinib and gefitinib are used for NSCLC with EGFR mutation
- the drug crizotinib is used for NSCLC with ALK mutation
Side effects of targeted therapy
Although targeted therapy drugs cause fewer side effects compared with standard chemotherapy drugs, they can still have side effects.
These vary depending on the targeted therapy drugs used, but may include an acne-like rash or other skin changes, diarrhoea, and nausea and vomiting. It’s important to discuss any side effects with your medical team.
These drugs can stimulate the body’s own immune system to attack the cancer. Immunotherapy may be effective in treating some forms of NSCLC such as squamous cell lung cancer.
Nivolumab and pembrolizumab are two immunotherapy drugs that work by permitting the immune system to bypass ‘checkpoints’ set up by the cancer that block the immune system. Both of these drugs block a protein called PD-1 found on immune cells. Nivolumab and pembrolizumab release this brake, allowing the immune system to attack cancer harder. Several checkpoint immunotherapy drugs are currently being tested in clinical trials for lung cancer.
Side effects of immunotherapy
The side effects of immunotherapy drugs are different to chemotherapy. They will vary depending on the organ affected, but may include shortness of breath (lungs) and diarrhoea (bowel).
If the cancer is advanced when it is first diagnosed or returns after treatment, your doctor will discuss palliative treatment for symptoms caused by the cancer, such as pain or breathlessness.
Palliative treatment aims to manage symptoms without trying to cure the disease. It can be used at any stage of advanced lung cancer to improve quality of life. It is not just for people who are about to die and does not mean giving up hope. Rather, it is about living for as long as possible in the most satisfying way you can.
As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. The treatment may include chemotherapy, radiotherapy and targeted therapy. If you are experiencing fluid build-up, you may have a procedure called thoracentesis or pleural tap to drain the extra fluid from the area between the lung and the chest wall (pleural space). See the managing symptoms section.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs. See more information about palliative care and living with advanced cancer or call Cancer Council 13 11 20.
Expert content reviewers:
Dr Dishan Herath, Medical Oncologist, Royal Melbourne Hospital, VIC; Sue Lilley, 13 11 20 Consultant, Cancer Council SA; Nev Middleton, Consumer; A/Prof Matthew Peters, Professor of Respiratory Medicine, Faculty of Medicine and Health Sciences, Macquarie University, and Senior Staff Specialist, Department of Respiratory Medicine, Concord Hospital, NSW; Dr Shawgi Sukumaran, Medical Oncologist, Flinders Medical Centre, SA; and A/Prof Shalini Vinod, Radiation Oncologist, Liverpool Hospital, NSW.