These include drugs that are targeted against cancer stem cells — which are thought to give rise to other cells in a tumor and be required for the tumor to spread — and drugs that target growth pathways normally present only in the developing embryo but that are reactivated in small cell lung cancer.
All of these approaches are experimental but have shown promise in the laboratory. We are also conducting studies to investigate the molecular factors that lead to small cell lung cancer. Understanding these factors holds hope for developing targeted therapies — a new class of drugs that can stop the progression of cancer by binding to specific molecular targets.
Even tumors that are completely removed during surgery or destroyed by radiation therapy can return if microscopic cancer cells have traveled from the primary tumor to other parts of the body.
Our doctors give chemotherapy to many patients with non-small cell lung cancer, either before or after surgery. Our medical oncologists work closely with your surgeon to determine whether adding chemotherapy to your treatment plan either before or after surgery could give you a better outcome. Which drugs you receive depends on what kind of non-small cell lung cancer you have: adenocarcinoma , squamous cell carcinoma , or large cell lung cancer.
Our doctors also consider the results from the genetic testing of your tumor, which may indicate that one chemotherapy regimen will work better than another. The first place where cancer cells spread from the lungs is often the lymph nodes also called lymph glands. This is because the lymph nodes act as a filter, trapping cancer cells as they travel out of the lungs.
MSK-led studies have shown that giving chemotherapy before surgery can improve cure rates in patients with non-small cell lung cancer that has spread to the lymph nodes.
This technique, called neoadjuvant chemotherapy, involves giving chemotherapy for several months prior to surgery.
In some cases, cancer cells in the lymph nodes can be completely eliminated before surgery. Because of this success in some patients, our doctors are continuing to test this approach using newer drug therapies. We have also begun offering neoadjuvant chemotherapy to patients with larger tumors that have not yet spread to the lymph nodes but have a high risk of returning despite successful surgery. Another approach is to give chemotherapy after surgery, called adjuvant chemotherapy.
Whether your doctor recommends this technique depends on a variety of factors, including the size of your tumor. Adjuvant chemotherapy is often prescribed when the cancer cells have spread to the lymph nodes. Traditional adjuvant chemotherapy can help you to live longer and improves your chance for a cure. For many patients, the best strategy may be to enroll in a clinical trial that tests new drugs.
At MSK, our goal is to use this information to identify the best treatment plan for you. Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 3 or 4 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week.
Then, at the end of the cycle, the chemo schedule repeats to start the next cycle. Adjuvant and neoadjuvant chemo is often given for 3 to 4 months, depending on the drugs used. The length of treatment for advanced lung cancer is based on how well it is working and what side effects you have.
For advanced cancers, the initial chemo combination is often given for 4 to 6 cycles. Some doctors now recommend giving treatment beyond this with a single chemo or targeted drug, in people who have had a good response to their initial chemotherapy or have had no worsening of their cancer.
Continuing this treatment, known as maintenance therapy , seems to help keep the cancer in check and help some people live longer. If the initial chemo treatment for advanced lung cancer is no longer working, the doctor may recommend second-line treatment with a single chemo drug such as docetaxel or pemetrexed, or with a targeted therapy or immunotherapy drug. Chemo drugs can cause side effects. A combination of drugs that work at different phases of cell division increases the chance of treating as many cancer cells as possible.
Since different cells are all on different timing in the process, repeated sessions also increase the chance of treating more cancer cells. Many side effects of chemotherapy are related to the "normal" effect of chemotherapy on rapidly dividing cells. Cells that divide most rapidly include those in bone marrow, hair follicles, and the digestive tract, so chemotherapy has a significant impact on these areas. Everyone responds to chemotherapy differently.
However, some side effects are common :. Another problem is neutropenia , a low white blood cell count seen in a majority of cancer patients. Having a low white blood cell count can predispose you to infections and sometimes cause very serious health concerns that, as a chemo patient, you should watch for and discuss with your healthcare provider.
What you will experience depends on the medications you're given and other factors such as your age, sex, and general medical condition. Thankfully, tremendous strides to help people manage these issues have been made over the past few decades.
Good nutrition is an essential part of staying strong during chemo treatments. Some people include complementary treatments such as nutritional supplements into their diets. Discuss any supplement use while undergoing chemo with your oncologist before doing so. Certain supplements can decrease the effectiveness of chemotherapy drugs for lung cancer, while others may make the medication toxic.
As for side effects, you may have few or you may have severe reactions to your medication s. These can improve or worsen over time. Sometimes a medication may need to be changed, but often there are medications and treatments that can control your symptoms and make you more comfortable. Some ways to manage side effects include:.
The management of chemo side effects has improved significantly in recent years. If you're struggling with the effects of these drugs, it may be helpful to join a cancer support group where you'll have the opportunity to talk to others who are experiencing similar challenges in their lives. Healthcare providers rarely use the word "cured" in relation to lung cancer. Even if you go into remission and have no evidence of cancer for years, the risk of dying from some cancers may persist for 15 years.
The reason chemotherapy does not cure lung cancer for good is that tumors become resistant to the drugs over time. Cancer cells are, in a way, "smart. Resistance is one reason why, when a tumor has started to grow again while someone is on chemotherapy, an oncologist may choose different drugs the next time around. With a combination of chemotherapy and immunotherapy, some people have experienced partial or complete remission of their cancer.
Though the word "cure" still isn't used in this situation, some cancers may be controlled for a long period of time. Oncologists call this a durable response. It's a lot to process when learning about the effectiveness of lung cancer treatments and their possible side effects. When chemotherapy for lung cancer is recommended, it can be a significant physical and emotional undertaking, especially at the beginning.
It may help to remember that the chemo of today is not the same as it was in the past, and that many side effects people once endured are less common due to improved treatments. Chemotherapy is still challenging, though, so you will need to build a strong support network to help you through the tough times. Surround yourself with those who can help you cope with all the phases and facets of treatment. Limiting processed foods and red meats can help ward off cancer risk.
These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide! American Cancer Society. Chemotherapy for Small Cell Lung Cancer. Updated February 17, In Vivo. Before or after: evolving neoadjuvant approaches to locally advanced non-small cell lung cancer. Front Oncol. Wu J, Waxman DJ. Immunogenic chemotherapy: Dose and schedule dependence and combination with immunotherapy.
Cancer Lett. Updated June 1,
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