Treatment of Metastatic Non-Small-Cell Lung Cancer

Articles On Treatment of Metastatic Non-Small-Cell Lung Cancer

Once non-small-cell lung cancer (NSCLC) spreads far and wide, treating it is kind of a balancing act. A cure isn't likely, but you can slow it down. So you aim to relieve your symptoms and improve your quality of life with as few side effects as possible.

Newer therapies can help you do just that. And there are a lot more options today than just a few years ago. The number of tumors, where they are, and your overall health all come in to play when deciding what to do.

Your doctor will start with a few tests to learn more about your NSCLC and help guide you to the best treatment.

When Targeted Therapy Works Best

Cancer comes about when a gene change causes a cell to grow and divide out of control. But you have so many genes, it's often hard to know which ones to blame.

With NSCLC though, doctors have tracked down a few of the culprits. When you have one of these known changes, you get targeted therapy. That means you take drugs that attack cancer cells in specific ways based on gene differences.

When Immunotherapy Makes the Most Sense

Your doctor will check tumor cells for their level of a protein called PD-L1. If it's high, immunotherapy is often the best place to start. It uses your immune system -- your body's defense against germs -- to attack cancer cells.

You may take atezolizumab (Tecentriq), nivolumab (Opdivo), or pembrolizumab (Keytruda). Durvalumab (Imfinzi) may also be given to treat certain types of NSCLC with a high level of PD-L1.These drugs help your immune system find and fight off cancer cells.

Some typical side effects include tiredness, cough, stomach upset, rash, and joint pain.

Chemotherapy

Chemo is the standard treatment when you don't have a gene change or high PD-L1. It uses drugs to kill cancer cells. Its side effects include hair loss, mouth sores, stomach upset, and more.

There are several chemo drugs used for NSCLC. For the best results, your doctor gives you two at a time. If your body isn't strong enough for two, even one can be helpful. You usually get four to six cycles of chemo, each taking about 3 weeks.

Once you're finished with treatment, you might keep taking what's called a maintenance drug. This is often another chemo medicine. Some research shows that this can slow the cancer down and help you live longer.

Your doctor may also add in some other drugs along with your chemo meds:

• For NSCLC, you might also take pembrolizumab (Keytruda), the immunotherapy drug. Or you might get bevacizumab (Avastin), another targeted drug. If so, you may keep taking one of these as your maintenance drug.
• For squamous NSCLC, your doctor might suggest the targeted therapy drug necitumumab (Portrazza).

Other Treatments

The brain, bones, and areas around the lungs are the most common places this cancer spreads. You'll get specific care based on where it ends up and what problems it causes.

In your bones, you may get radiation to curb pain. When it causes fluid to build up around your lungs, you might need a thin tube in your chest to drain it more easily.

If it's in just one other place, like your brain or adrenal gland, you might have surgery to remove the tumor.

Changing Treatments

Sometimes, the first therapy you try doesn't work as well as you'd hope. But you still have options.

If you started with immunotherapy, your doctor may suggest chemo. If you started with one set of chemo drugs, you might try another or add in targeted therapy. It depends on your health, how far the cancer has spread, and what you want from treatment.

This is also why you want to start an approach called palliative care early on. It aims to keep you as comfortable as possible and help you manage stress.

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