“Patients that have received a lung cancer diagnosis have every reason to be hopeful.”
Getting a lung cancer diagnosis today is much different than it was 15, 10, even five years ago. “We have seen an explosion of new treatment modalities that have become available for the treatment of lung cancer,” says Kevin Sullivan, MD, a lung oncologist at Monter Cancer Center, Northwell Health. “For patients that have received a lung cancer diagnosis, they have every reason to be hopeful.”
How Lung Cancer Is Treated
There are many effective therapies for treating lung cancer. Choosing the right treatment depends on the stage of your cancer and what course of treatment works best for your lifestyle.
Here are the five main lung cancer treatment types:
The goal of surgery for lung cancer is to remove the tumor from the body. Surgeons do this by removing part of the lung (segmentectomy), a lobe of the lung (lobectomy), or the entire lung (pneumonectomy).
Lung cancer surgery is considered the best option when the cancer is localized to one area and has not spread. “If the tumor is the only site of disease in the body, [surgery] could potentially cure,” says Jorge Gomez, MD, a lung oncologist at Mount Sinai Hospital.
2. Radiation therapy
Radiation therapy aims to kill cancer cells via high-energy rays (such as X-rays) or particles. Radiation therapy—when used in combination with chemotherapy—can potentially cure patients with locally advanced disease that has not spread outside the chest, says Dr. Gomez.
Treatments for Advanced Lung Cancer
The following three therapies are generally used to treat advanced lung cancer (stage 3B or stage 4) or metastatic disease (when lung cancer has spread to other parts of the body). “All three [treatments] try to shrink the disease,” says Dr. Gomez.
Chemotherapy is a type of anti-cancer treatment that enters the bloodstream (by injection or by mouth) and kills rapidly dividing cells (which tend to be cancer cells). Chemotherapy for lung cancer may be used in conjunction with radiation therapy, before or after surgery, or as the main treatment.
4. Targeted therapy
“In the past 15 years, lung cancer has changed significantly,” says Dr. Gomez. “The first thing that happened was the discovery of targeted therapies.”
As researchers have learned more about the changes in cancer cells that help them grow, they have developed targeted therapies to target those changes specifically. “Targeted therapies are really going after the specific cause, the specific molecule that’s abnormal and producing the cancer,” says Dr. Gomez.
Targeted therapies work differently from standard chemotherapy drugs. Chemotherapies are designed to kill any rapidly dividing cell, but because they don’t have a specific target, they kill healthy cells as well.
The only drawback to targeted therapies, however, is that they can’t help all lung cancer patients. “There is a group of patients, approximately 15 to 20 percent of patients with lung cancer, who have a special type of lung cancer that can be treated with targeted therapies,” says Dr. Gomez.
“Immunotherapies are drugs that activate the body’s immune system to attack the cancer,” says Dr. Gomez. “They don’t attack the cancer themselves the way chemotherapy does.”
Various types of immunotherapy are being developed to help the immune system recognize a tumor as something different than the normal tissues in the body. One of these immunotherapy approaches is a class of medications called checkpoint inhibitors.
Here’s how they work: An important characteristic of the immune system is to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints”—which are proteins on immune cells that must be turned on (or off) to trigger an immune response.
Cancer cells sometimes use these checkpoints to essentially hide from and avoid being attacked by the immune system. “Cancer has an incredible ability to evade immune detection,” says Dr. Sullivan. “The cancer can interact with those proteins and shut off the immune response.”
That’s where the immunotherapies come into play. “These immune checkpoint inhibitors are actually antibodies that get infused into the bloodstream, and the antibody has a very specific target,” says Dr. Sullivan. The antibodies target and block the interaction between the cancer cells and the immune cells that allows the cancer to “hide” from the immune response.
“So by blocking that immune checkpoint, the immune system is now able to recognize the cancer as something foreign and attack it,” says Dr. Sullivan. “It’s basically an unleashing of the immune system against our cancer cells.”
The goal of treatment in patients with advanced disease is to prolong life and to improve quality of life. “We improve quality of life by illuminating the symptoms of the disease and all of those three therapies can do that,” says Dr. Gomez.
00:00:01,930 --> 00:00:05,789
The treatment of lung cancer has changed
significantly over the past five to
00:00:05,789 --> 00:00:06,399
00:00:06,399 --> 00:00:09,903
We have seen an explosion of
new treatment modalities and
00:00:09,903 --> 00:00:14,724
new medications that have become available
for the treatment of lung cancer.
00:00:14,724 --> 00:00:16,608
Some that are very specific for
00:00:16,608 --> 00:00:20,231
the specific type of lung cancer
that a patient might have,
00:00:20,231 --> 00:00:24,516
and others that are more generalizable
to broader groups of patients.
00:00:24,516 --> 00:00:28,440
00:00:28,440 --> 00:00:32,303
We have broadly five different
treatments in lung cancer,
00:00:32,303 --> 00:00:36,318
the first is surgery,
which aims to take out tumors, and so,
00:00:36,318 --> 00:00:41,672
if the tumor is the only site of disease
in the body, that could potentially cure.
00:00:41,672 --> 00:00:43,596
The second is radiation therapy and
00:00:43,596 --> 00:00:48,276
radiation therapy can be used to cure when
it's used in combination with chemotherapy
00:00:48,276 --> 00:00:53,730
in patients with locally advanced disease
that has not spread outside of the chest.
00:00:53,730 --> 00:00:57,921
The other three therapies we use are
generally used in patients with advanced
00:00:57,921 --> 00:01:01,789
or metastatic disease and
those are chemotherapy, immunotherapy and
00:01:01,789 --> 00:01:02,897
00:01:02,897 --> 00:01:05,521
All three of them try
to shrink the disease.
00:01:05,521 --> 00:01:09,147
The goal of treatment in
patients with advanced disease is
00:01:09,147 --> 00:01:12,561
really to prolong life and
to improve quality of life.
00:01:12,561 --> 00:01:17,294
And so we improve quality of life by
eliminating the symptoms of the disease
00:01:17,294 --> 00:01:20,162
and all of those three
therapies can do that.
00:01:20,162 --> 00:01:24,606
In the past 15 years, lung cancer
treatment has changed significantly.
00:01:24,606 --> 00:01:29,500
The first thing that happened was
the discovery of targeted therapies.
00:01:29,500 --> 00:01:32,365
There is a group of patients,
approximately 15 or
00:01:32,365 --> 00:01:36,920
20% of patients with lung cancer, who have
a special type of lung cancer that can
00:01:36,920 --> 00:01:39,740
be treated with pills,
with targeted therapies.
00:01:39,740 --> 00:01:42,644
And those patients are usually
never smokers, but
00:01:42,644 --> 00:01:44,534
this can happen in smokers also.
00:01:44,534 --> 00:01:49,150
Their lung cancers are generally
thought not to be related to tobacco.
00:01:49,150 --> 00:01:51,562
And so for that segment of the population,
00:01:51,562 --> 00:01:55,048
this treatment is significantly
better than chemotherapy.
00:01:55,048 --> 00:01:59,313
The next big finding has really been
the appearance of immunotherapies.
00:01:59,313 --> 00:02:03,786
Immunotherapies are drugs that activate
the body's immune system to attack
00:02:03,786 --> 00:02:04,640
00:02:04,640 --> 00:02:08,896
They don't attack the cancer themselves
the way chemotherapy does, and
00:02:08,896 --> 00:02:12,819
these drugs are now approved in
almost all settings of lung cancer.
00:02:12,819 --> 00:02:16,726
For immunotherapies, the main ones,
these immune checkpoint
00:02:16,726 --> 00:02:21,646
inhibitors are actually antibodies that
get infused into the blood stream, and
00:02:21,646 --> 00:02:24,830
the antibody has a very specific target.
00:02:24,830 --> 00:02:28,553
It targets that interaction
between the cancer cell and
00:02:28,553 --> 00:02:33,001
the immune system cell that enables
it to evade immune detection.
00:02:33,001 --> 00:02:37,929
So by blocking that immune checkpoint,
the immune system is now
00:02:37,929 --> 00:02:43,610
able to recognize the cancer as
something foreign and attack it.
00:02:43,610 --> 00:02:48,301
So it's basically like an unleashing
of the immune system against
00:02:48,301 --> 00:02:49,648
our cancer cells.
00:02:49,648 --> 00:02:53,174
For patients who have received
a lung cancer diagnosis,
00:02:53,174 --> 00:02:55,900
they have every reason to be hopeful.
00:02:55,900 --> 00:02:59,288
There are many different
treatment options available, and
00:02:59,288 --> 00:03:01,690
every day we're learning something new.
00:03:01,690 --> 00:03:05,012
And patients' outcomes
are improving with this disease.
00:03:05,012 --> 00:03:14,515
Patient education: Non-small cell lung cancer treatment; stage IV cancer (Beyond the Basics). UpToDate. (Accessed on January 15, 2019 at https://www.uptodate.com/contents/non-small-cell-lung-cancer-treatment-stage-iv-cancer-beyond-the-basics)
Immunotherapy for Non-Small Cell Lung Cancer. American Cancer Society. (Accessed on January 15, 2019 at https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/immunotherapy.html)
Targeted Therapy Drugs for Non-Small Cell Lung Cancer. American Cancer Society. (Accessed on January 15, 2019 at https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/targeted-therapies.html)
Treatment Choices for Non-Small Cell Lung Cancer, by Stage. American Cancer Society. (Accessed on January 15, 2019 at https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/by-stage.html)
Lung Cancer Surgery. American Lung Association. (Accessed on January 15, 2019 at https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-cancer/patients/treatment/types-of-treatment/lung-cancer-surgery.html)