Talk to your doctor about the risks and benefits before you start any kind of complementary or alternative medicine. Choosing the treatment that is right for you may be hard. Talk to your cancer doctor about the treatment options available for your type and stage of cancer. Your doctor can explain the risks and benefits of each treatment and their side effects.
Side effects are how your body reacts to drugs or other treatments. Sometimes people get an opinion from more than one cancer doctor. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Lung Cancer. Section Navigation. Facebook Twitter LinkedIn Syndicate. Minus Related Pages. People with non-small cell lung cancer can be treated with surgery.
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Section Menu. Key Points Your lung cancer treatment options are determined by your lung cancer type, lung cancer stage, and lung cancer treatment goals. You may receive several different types of treatment for lung cancer. You and your care team make decisions about lung cancer treatment together. The following immunotherapy drugs block this pathway:. Another immune pathway that may be targeted is the CTLA-4 pathway. In lung cancer, this pathway is often blocked in combination with a drug blocking the PD-1 pathway.
For most people with advanced NSCLC that cannot be treated with a targeted therapy see above , immunotherapy or immunotherapy plus chemotherapy is often the preferred initial treatment. Different types of immunotherapy can cause different side effects but, in general, severe side effects are less common than with chemotherapy. Common side effects include skin reactions, flu-like symptoms, diarrhea, lung inflammation causing shortness of breath, and weight changes.
Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy and its side effects. Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
A tumor in the chest that is bleeding or blocking the lung passages can be shrunk with radiation therapy. During a bronchoscopy See Diagnosis , lung passages blocked by cancer can be opened to improve breathing.
A surgeon or pulmonologist can place a stent to prop open an airway or use a laser to burn away a tumor. Medications are used to treat cancer pain. Most hospitals and cancer centers have pain control specialists who provide pain relief, even for severe cancer pain. Many drugs used to treat cancer pain, especially morphine, can also relieve shortness of breath caused by cancer.
Learn more about managing cancer pain. Prednisone or methylprednisolone A-Methapred, Depo-Medrol, Medrol, Solu-Medrol can reduce inflammation caused by lung cancer or radiation therapy and improve breathing. Medications are available to strengthen bones, lessen bone pain, and help prevent future bone metastases. Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem.
Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future. Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website. Your doctor will recommend a specific treatment plan for you based on the cancer's stage and other factors.
Detailed descriptions of each type of treatment are provided earlier on this page. Clinical trials may also be a treatment option for each stage. Surgeons cure many people with an operation. Before or after surgery, a patient may also meet with a medical oncologist. Some people with a large tumor or signs that the tumor has spread to the lymph nodes may benefit from chemotherapy.
Chemotherapy may be given before the surgery, called neoadjuvant chemotherapy or induction chemotherapy. Chemotherapy may also be given after surgery, called adjuvant chemotherapy, to reduce the chance that the cancer will return.
Patients with stage IB cancers should talk with their doctors about whether chemotherapy is right for them after surgery.
Treatment options depend on the size and location of the tumor and the lymph nodes that are involved. The options generally include:. A combination of chemotherapy and radiation therapy followed by immunotherapy is usually recommended for NSCLC that cannot be removed with surgery.
Chemotherapy and radiation therapy may be given together, which is called concurrent chemoradiotherapy. Or, they may be given one after the other, called sequential chemoradiotherapy.
Surgery may be an option after initial chemotherapy or chemotherapy with radiation therapy. Sometimes, surgery may be the first treatment, particularly when cancer is found in the lymph nodes unexpectedly after a person has originally been diagnosed with stage I or stage II cancer.
If this occurs, surgery is generally followed by chemotherapy and often radiation therapy. Adjuvant cisplatin-based chemotherapy is recommended for people with stage IIIA lung cancers that have been completely removed with surgery. Patients should talk with their doctor about the best treatment options for them.
If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan. Occasionally, doctors may recommend surgery or radiation therapy for a metastasis in the brain or adrenal gland if that is the only place the cancer has spread.
Radiation therapy may also be used to treat a localized area that may be causing pain. People with stage IV disease have a very high risk of the cancer spreading or growing in another location. Most patients with this stage of NSCLC receive systemic therapies, such as chemotherapy, targeted therapy, or immunotherapy. Palliative care will also be important to help relieve symptoms and side effects. These treatments can occasionally make metastatic lung cancer disappear.
However, doctors know from experience that the cancer will usually return. If the cancer worsens or causes too many severe side effects, the treatment may be stopped. Patients would continue to receive palliative care and may be offered treatment in a clinical trial. No specific treatment or combination of treatments works for every patient.
If the first-line treatment causes too many or dangerous side effects, does not appear to be working, or stops working, the doctor may recommend a change in treatment. All patients should also receive palliative care. First-line treatment. Two key variables to consider when determining treatment are PD-L1 score and whether there are alterations in the DNA that can be targeted with certain medications.
In , the FDA approved more treatment options: histology-specific chemotherapy plus nivolumab and ipilimumab; nivolumab combined with ipilimumab; and atezolizumab alone.
In those who cannot receive immunotherapy, a combination of 2 chemotherapy drugs is recommended. Pembrolizumab alone may be recommended for people who cannot receive a combination of pembrolizumab with a platinum chemotherapy. In , the FDA approved more treatment options: histology-specific chemotherapy with nivolumab and ipilimumab, and nivolumab combined with ipilimumab. In , the FDA also approved histology-specific chemotherapy with nivolumab and ipilimumab.
In , the FDA approved more treatment options: histology-specific chemotherapy plus nivolumab and ipilimumab, and atezolizumab alone. Pembrolizumab alone may be recommended for people who cannot receive chemotherapy. In , the FDA approved more treatment options: a combination of histology-specific chemotherapy plus nivolumab and ipilimumab, and nivolumab combined with ipilimumab.
In , the FDA approved histology-specific chemotherapy with nivolumab and ipilimumab. EGFR gene mutations. Treatments with targeted therapies called TKIs may be options. Treatment with TKIs with or without chemotherapy may also be offered to certain patients as well as chemotherapy combinations with or without bevacizumab.
ALK fusions. Targeted therapy options are alectinib, brigatinib, ceritinib, crizotinib, or lorlatinib. ROS1 fusions. Targeted therapy options are entrectinib, crizotinib, or chemotherapy with or without immunotherapy. Targeted therapy options are dabrafenib and trametinib or chemotherapy with or without immunotherapy.
MET exon 14 skipping mutations. Targeted therapy options are capmatinib, tepotinib, or chemotherapy with or without immunotherapy. RET fusions. Targeted therapy options are selpercatinib, pralsetinib Gavreto , or chemotherapy with or without immunotherapy. NTRK fusions. Targeted therapy options are entrectinib, larotrectinib, or chemotherapy with or without immunotherapy. Second-line treatment.
Second-line treatment for NSCLC depends on the gene mutations found in the tumor and the treatments patients have already received. If chemotherapy and immunotherapy were already given in the first line of treatment, then docetaxel with or without ramucirumab should be given in the second line. If osimertinib was not given in the first line, it should be given in the second line.
If an EGFR inhibitor was already given, then chemotherapy with or without bevacizumab, immunotherapy, or both should be given. If crizotinib was already given, then the next treatment should be alectinib, brigatinib, or lorlatinib. If alectinib or brigatinib was already given, then the next treatment should be lorlatinib. If lorlatinib has already been given, then chemotherapy with or without immunotherapy, bevacizumab, or both should be given.
If a TKI was already used in the first line, then chemotherapy with or without immunotherapy, bevacizumab, or both should be given. In all cases, patients and their doctors should discuss any reasons why some patients may not be able to receive immunotherapy and other treatment options described above.
This information is based on several ASCO recommendations for the treatment of lung cancer.
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