CIENCIASMEDICASNEWS: Non-Small Cell Lung Cancer Treatment (PDQ®) 3/3 —Patient Version

Non-Small Cell Lung Cancer Treatment (PDQ®)—Patient Version - National Cancer Institute

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Stereotactic body radiation therapy is a type of external radiation therapy. Special equipment is used to place the patient in the same position for each radiation treatment. Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor. By having the patient in the same position for each treatment, there is less damage to nearby healthy tissue. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.

Stereotactic radiosurgery is a type of external radiation therapy used to treat lung cancer that has spread to the brain. A rigid head frame is attached to the skull to keep the head still during the radiation treatment. A machine aims a single large dose of radiation directly at the tumor in the brain. This procedure does not involve surgery. It is also called stereotaxic radiosurgery, radiosurgery, and radiation surgery.

For tumors in the airways, radiation is given directly to the tumor through an endoscope.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. It also depends on where the cancer is found. External and internal radiation therapy are used to treat non-small cell lung cancer.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

See Drugs Approved for Non-Small Cell Lung Cancer for more information.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Monoclonal antibodies and tyrosine kinase inhibitors are the two main types of targeted therapy being used to treat advanced, metastatic, or recurrent non-small cell lung cancer.

Monoclonal antibodies

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances in the blood or tissues that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

There are different types of monoclonal antibody therapy:

Vascular endothelial growth factor (VEGF) inhibitor therapy: Cancer cells make a substance called VEGF, which causes new blood vessels to form (angiogenesis) and helps the cancer grow. VEGF inhibitors block VEGF and stop new blood vessels from forming. This may kill cancer cells because they need new blood vessels to grow. Bevacizumab and ramucirumab are VEGF inhibitors and angiogenesis inhibitors.
Epidermal growth factor receptor (EGFR) inhibitor therapy: EGFRs are proteins found on the surface of certain cells, including cancer cells. Epidermal growth factor attaches to the EGFR on the surface of the cell and causes the cells to grow and divide. EGFR inhibitors block the receptor and stop the epidermal growth factor from attaching to the cancer cell. This stops the cancer cell from growing and dividing. Cetuximab and necitumumab are EGFR inhibitors.

Tyrosine kinase inhibitors

Tyrosine kinase inhibitors are small-molecule drugs that go through the cell membraneand work inside cancer cells to block signals that cancer cells need to grow and divide. Some tyrosine kinase inhibitors also have angiogenesis inhibitor effects.

There are different types of tyrosine kinase inhibitors:

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors: EGFRs are proteins found on the surface and inside certain cells, including cancer cells. Epidermal growth factor attaches to the EGFR inside the cell and sends signals to the tyrosine kinase area of the cell, which tells the cell to grow and divide. EGFR tyrosine kinase inhibitors stop these signals and stop the cancer cell from growing and dividing. Erlotinib, gefitinib, afatinib, and osimertinib are types of EGFR tyrosine kinase inhibitors. Some of these drugs work better when there is also a mutation (change) in the EGFR gene.
Kinase inhibitors that affect cells with certain gene changes: Certain changes in the ALKand ROS1 genes cause too much protein to be made. Blocking these proteins may stop the cancer from growing and spreading. Crizotinib is used to stop proteins from being made by the ALK and ROS1 genes. Ceritinib, alectinib, and brigatinib are used to stop proteins from being made by the ALK gene. Dabrafenib is used to stop proteins being made by the BRAF gene. Trametinib is used to stop proteins being made by the MEKgene.

See Drugs Approved for Non-Small Cell Lung Cancer for more information.

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

Immune checkpoint inhibitor therapy is a type of immunotherapy.

Immune checkpoint inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. Nivolumab, pembrolizumab, atezolizumab, and durvalumab are types of immune checkpoint inhibitors.

Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells. — Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).

Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.

See Drugs Approved for Non-Small Cell Lung Cancer for more information.

Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue. It is used mainly to treat tumors on or just under the skin or in the lining of internal organs. When the tumor is in the airways, PDT is given directly to the tumor through an endoscope.

Cryosurgery

Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy. For tumors in the airways, cryosurgery is done through an endoscope.

Electrocautery

Electrocautery is a treatment that uses a probe or needle heated by an electric current to destroy abnormal tissue. For tumors in the airways, electrocautery is done through an endoscope.

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change. This may be done in certain rare cases of non-small cell lung cancer.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Chemoprevention

Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of cancer or to reduce the risk cancer will recur (come back). For lung cancer, chemoprevention is used to lessen the chance that a new tumor will form in the lung.

Radiosensitizers

Radiosensitizers are substances that make tumor cells easier to kill with radiation therapy. The combination of chemotherapy and radiation therapy given with a radiosensitizer is being studied in the treatment of non-small cell lung cancer.

New combinations

New combinations of treatments are being studied in clinical trials.

Treatment for non-small cell lung cancer may cause side effects.

For information about side effects caused by treatment for cancer, see our Side Effectspage.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

For information about the treatments listed below, see the Treatment Option Overviewsection.

Occult Non-Small Cell Lung Cancer

Treatment of occult non-small cell lung cancer depends on the stage of the disease. Occult tumors are often found at an early stage (the tumor is in the lung only) and sometimes can be cured by surgery.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Stage 0

Treatment of stage 0 may include the following:

Surgery (wedge resection or segmental resection).
Photodynamic therapy, electrocautery, cryosurgery, or laser surgery for tumors in or near the bronchus.

Stage I Non-Small Cell Lung Cancer

Treatment of stage IA non-small cell lung cancer and stage IB non-small cell lung cancermay include the following:

Surgery (wedge resection, segmental resection, sleeve resection, or lobectomy).
External radiation therapy, including stereotactic body radiation therapy for patients who cannot have surgery or choose not to have surgery.
A clinical trial of chemotherapy or radiation therapy following surgery.
A clinical trial of treatment given through an endoscope, such as photodynamic therapy (PDT).
A clinical trial of surgery followed by chemoprevention.

Stage II Non-Small Cell Lung Cancer

Treatment of stage IIA non-small cell lung cancer and stage IIB non-small cell lung cancermay include the following:

Surgery (wedge resection, segmental resection, sleeve resection, lobectomy, or pneumonectomy).
Chemotherapy followed by surgery.
Surgery followed by chemotherapy.
External radiation therapy for patients who cannot have surgery.
A clinical trial of radiation therapy following surgery.

Stage IIIA Non-Small Cell Lung Cancer

Treatment of stage IIIA non-small cell lung cancer that can be removed with surgery may include the following:

Surgery followed by chemotherapy.
Surgery followed by radiation therapy.
Chemotherapy followed by surgery.
Surgery followed by chemotherapy combined with radiation therapy.
Chemotherapy and radiation therapy followed by surgery.
A clinical trial of new combinations of treatments.

Treatment of stage IIIA non-small cell lung cancer that cannot be removed with surgery may include the following:

Chemotherapy and radiation therapy given over the same period of time or one followed by the other.
External radiation therapy alone for patients who cannot be treated with combined therapy, or as palliative treatment to relieve symptoms and improve the quality of life.
Internal radiation therapy or laser surgery, as palliative treatment to relieve symptoms and improve the quality of life.
Chemotherapy and radiation therapy followed by immunotherapy with an immune checkpoint inhibitor, such as durvalumab.
A clinical trial of new combinations of treatments.

For more information about supportive care for signs and symptoms including cough, shortness of breath, and chest pain, see the PDQ summary on Cardiopulmonary Syndromes.

Non-small cell lung cancer of the superior sulcus, often called Pancoast tumor, begins in the upper part of the lung and spreads to nearby tissues such as the chest wall, large blood vessels, and spine. Treatment of Pancoast tumors may include the following:

Radiation therapy alone.
Surgery.
Chemotherapy and radiation therapy followed by surgery.
A clinical trial of new combinations of treatments.

Some stage IIIA non-small cell lung tumors that have grown into the chest wall may be completely removed. Treatment of chest wall tumors may include the following:

Surgery.
Surgery and radiation therapy.
Radiation therapy alone.
Chemotherapy combined with radiation therapy and/or surgery.
A clinical trial of new combinations of treatments.

Stage IIIB and Stage IIIC Non-Small Cell Lung Cancer

Treatment of stage IIIB non-small cell lung cancer and stage IIIC non-small cell lung cancermay include the following:

Chemotherapy followed by external radiation therapy.
Chemotherapy and radiation therapy given as separate treatments over the same period of time.
Chemotherapy and radiation therapy given as separate treatments over the same period of time, with the dose of radiation therapy increasing with time.
Chemotherapy and radiation therapy given as separate treatments over the same period of time. Chemotherapy alone is given before or after these treatments.
Chemotherapy and radiation therapy followed by immunotherapy with an immune checkpoint inhibitor, such as durvalumab.
External radiation therapy alone for patients who cannot be treated with chemotherapy.
External radiation therapy as palliative therapy, to relieve symptoms and improve the quality of life.
Laser therapy and/or internal radiation therapy to relieve symptoms and improve the quality of life.
Clinical trials of new external radiation therapy schedules and new types of treatment.
A clinical trial of chemotherapy and radiation therapy combined with a radiosensitizer.
Clinical trials of targeted therapy combined with chemotherapy and radiation therapy.

For more information about supportive care for signs and symptoms such as cough, shortness of breath, and chest pain, see the following PDQ summaries:

Newly Diagnosed Stage IV, Relapsed, and Recurrent Non-Small Cell Lung Cancer

Treatment of newly diagnosed stage IV, relapsed, and recurrent non-small cell lung cancermay include the following:

Combination chemotherapy.
Combination chemotherapy and targeted therapy with a monoclonal antibody, such as bevacizumab, cetuximab, or necitumumab.
Combination chemotherapy followed by more chemotherapy as maintenance therapyto help keep cancer from progressing.
Targeted therapy with an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, such as osimertinib, gefitinib, erlotinib, or afatinib.
Targeted therapy with an anaplastic lymphoma kinase (ALK) inhibitor, such as alectinib, crizotinib or ceritinib.
Targeted therapy with a BRAF or MEK inhibitor, such as dabrafenib or trametinib.
Immunotherapy with an immune checkpoint inhibitor, such as pembrolizumab, with or without chemotherapy.
Laser therapy and/or internal radiation therapy for tumors that are blocking the airways.
External radiation therapy as palliative therapy, to relieve symptoms and improve the quality of life.
Surgery to remove a second primary tumor.
Surgery to remove cancer that has spread to the brain, followed by radiation therapy to the whole brain.
Stereotactic radiosurgery for tumors that have spread to the brain and cannot be treated with surgery.
A clinical trial of new drugs and combinations of treatments.

Progressive Stage IV, Relapsed, and Recurrent Non-Small Cell Lung Cancer

Treatment of progressive stage IV, relapsed, and recurrent non-small cell lung cancer may include the following:

Chemotherapy.
Targeted therapy with an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, such as erlotinib, gefitinib, afatinib, or osimertinib.
Targeted therapy with an anaplastic lymphoma kinase (ALK) inhibitor, such as crizotinib, ceritinib, alectinib, or brigatinib.
Targeted therapy with a BRAF or MEK inhibitor, such as dabrafenib or trametinib.
Immunotherapy with an immune checkpoint inhibitor, such as nivolumab, pembrolizumab, or atezolizumab.
A clinical trial of new drugs and combinations of treatments.

To Learn More About Non-Small Cell Lung Cancer

For more information from the National Cancer Institute about non-small cell lung cancer, see the following:

Lung Cancer Home Page
Lung Cancer Prevention
Lung Cancer Screening
Drugs Approved for Non-Small Cell Lung Cancer
Targeted Cancer Therapies
Lasers in Cancer Treatment
Photodynamic Therapy for Cancer
Cryosurgery in Cancer Treatment
Tobacco (includes help with quitting)
Secondhand Smoke and Cancer

For general cancer information and other resources from the National Cancer Institute, see the following:

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of non-small cell lung cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Adult Treatment Editorial Board. PDQ Non-Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389355]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.