Tremendous strides have been made with regard to the treatment of lung cancer. Clinicians often consider numerous factors when deciding on a treatment plan, such as patient’s age, overall health and medical history, and the type and stage of lung cancer. Clinicians will also consider the patient’s treatment preferences via shared decision-making. Treatment may include surgery, chemotherapy, immunotherapy or other pharmacological agents, radiation therapy, or a combination of treatments.

Management of Non-Small Cell Lung Cancer (NSCLC)

Treatment for NSCLC entails an assessment of eligibility for surgery. Choice of surgery, chemotherapy, radiation therapy, or a combination of treatments depends on tumor type and stage, which are tailored to the patient’s needs as appropriate. According to the National Institutes of Health’s National Cancer Institute (NIH NCI), results of standard NSCLC treatment are poor except for the most localized cancers. The NIH NCI also indicates that all newly diagnosed patients with NSCLC are potential candidates for studies evaluating new forms of treatment.

Targeted Therapies for NSCLC

Treatment of NSCLC is based on precision medicine, and molecular analysis is performed on adenocarcinomas to explore for specific mutations that can direct therapy. The field of precision medicine is swiftly advancing, and additional drugs are being evaluated. Additionally, there are several immuno-oncology drugs (nivolumab, pembrolizumab, durvalumab, and atezolizumab) that are available for NSCLC treatment. These drugs stimulate immune responsiveness, assist in allowing the cancer to be recognized as foreign, and prevent the tumor’s ability to block the natural immune system response. These agents are often prescribed if the tumor advances despite chemotherapy (most often platinum-based doublets), and extensive research is being conducted to determine which tumors will respond to this treatment.  

Recurrent Lung Cancer

Treatment options for recurrent lung cancer may vary by location and include repeat chemotherapy or targeted drugs for metastases, radiation therapy for local recurrence or pain caused by metastases, and brachytherapy for endobronchial disease when additional external radiation cannot be tolerated. Surgical resection of a solitary metastasis or for palliative purposes is rarely considered.

The treatment of a locally recurrent NSCLC follows the same guidelines as for primary tumor stages I through III. If surgery was performed initially, radiation therapy is the primary modality. If the recurrence manifests as distant metastases, patients are treated as if they have stage IV disease with a focus on palliation.

Treatment for recurrent or metastatic stage IV NSCLC includes chemotherapy or targeted drugs, and treatment choice depends on tumor histology, mutational profile, patient functional status, and patient preference.

Treatment Options for Small Cell Lung Cancer (SCLC)

On average, SCLC at any stage is initially responsive to treatment, but unfortunately responses are generally short-lived. Chemotherapy, with or without radiation therapy, is offered depending on the stage of disease. In many patients, chemotherapy prolongs survival and improves quality of life enough to warrant its use. Surgery generally plays no role in the treatment of SCLC, although it may be curative in the rare patient who has a small focal tumor without spread (such as a solitary pulmonary nodule) and who underwent surgical resection before the tumor was identified as SCLC.

Chemotherapy regimens of etoposide and a platinum compound (either cisplatin or carboplatin) are commonly used. In addition, other drugs such as irinotecan, topotecan, vinca alkaloids (vinblastine, vincristine, vinorelbine), alkylating agents (cyclophosphamide, ifosfamide), doxorubicin, taxanes (docetaxel, paclitaxel), and gemcitabine can be used.

The NIH NCI indicates that chemotherapy and radiation therapy have been demonstrated to improve survival for patients with SCLC. The NIH NCI also notes that, in spite of treatment advances, the majority of patients with SCLC have a poor prognosis, even with the best available therapy. They also note that the majority of the improvements in the survival of patients with SCLC are due to clinical trials that have endeavored to expand and enhance therapies.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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