Lung Cancer medications & treatments
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Lung cancer is the third most common cancer in the United States and is the leading cause of cancer-related deaths for American men and women. There are approximately 225,000 new cases of lung cancer in the U.S. each year, while an estimated 160,000 will die because of this condition. More Americans die of lung cancer than prostate, brain, colorectal, and breast cancer combined.
What is lung cancer?
Lung cancer is a disease in which cells in the lung grow out of control and form masses known as tumors. It can spread to lymph nodes or other organs in the body, such as the brain.
There are 2 main types of lung cancer:
- Non-small cell lung cancer (NSCLC). This is the most common type of lung cancer. Approximately 85% of lung cancer patients have NSCLC. There are several types of NSCLC including squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
- Small cell lung cancers (SCLC). SCLC accounts for about 15% of lung cancer cases. It differs from NSCLC in several ways including where the cancer started, the cells’ appearance under a microscope, and how quickly the cancer grows.
Lung cancer causes
Research has found that the following risk factors can increase your chances of developing lung cancer:
- Smoking. Approximately 90% of lung cancer cases are caused by smoking. Your risk of lung cancer is dependent on how many cigarettes you smoke a day and how long you have smoked. Smokers are 15 to 30 times more likely to develop lung cancer or die from it than people who don’t smoke.
- Secondhand smoke. Exposure to secondhand smoke from other people can also increase your risk of lung cancer.
- Radon. Radon is the second leading cause of lung cancer behind smoking. It is a gas that has no taste or smell. Radon naturally forms in rocks, soil, and water. It can accumulate in your home and you do not know it. Over time, breathing in this gas can cause lung cancer. It’s estimated that radon causes around 21,000 lung cancer deaths every year.
- Personal or family history of lung cancer. If you have had a previous case of lung cancer you are at risk of it coming back. If you have a parent, sibling, or child who has had lung cancer, you are as twice as likely to develop it as someone without a family history of lung cancer.
- Radiation therapy. If you have had radiation therapy to the chest for a different type of cancer, you are at an increased risk of developing lung cancer.
- Chemical exposure. Your risk of lung cancer is increased if you have been exposed to carcinogens such as asbestos, arsenic, and chromium.
- Air pollution. Exposure to pollutants in the air such as diesel exhaust can increase your risk.
- Beta-carotene supplements. If you smoke, taking high-dose beta-carotene supplements over a long period of time can increase your risk of lung cancer.
How is lung cancer diagnosed?
While a biopsy is the only way to confirm a lung cancer diagnosis, your doctor may also look at your medical history, perform imaging tests, and biomarker tests, and run some labs.
Lung cancer symptoms
The majority of lung cancer patients don’t experience symptoms in the early stages. The most common symptoms of lung cancer include:
- A lingering or worsening cough
- Coughing up blood
- Shortness of breath
- Chest pain or shoulder pain
- Loss of appetite
- Weight loss for no known reason
- Recurring respiratory infections such as bronchitis or pneumonia
- Chest x-ray. This may be the first test your doctor will perform to look for a mass if they suspect you have lung cancer. X-rays can often miss early-stage lung cancer so your doctor may run more tests if nothing is found.
- Computed tomography (CT scan). A CT scan creates three-dimensional (3D) views of your lung to identify any masses. It can show the size, shape, and position of any lung tumor as well as if it has spread to other areas of the body (metastasis).
- Positron emission tomography scan (PET scan). A PET scan involves injecting a radioactive form of sugar into your bloodstream. If there is a tumor present, it will absorb the radioactive sugar faster than healthy cells and show up when scanned. It is often combined with a CT scan using a machine that can perform them at the same time.
- Magnetic resonance imaging scan (MRI). An MRI uses radio waves and strong magnets to see if the cancer has spread to the brain or spinal cord.
- Blood tests. Blood tests cannot confirm lung cancer, but your doctor may perform them to give them a picture of your general health.
- Sputum cytology. This test involves collecting samples of your phlegm coughed up from your lungs for 3 mornings in a row. It can help diagnose lung cancers that start in the major airways of the lung but not other types of lung cancer.
Your doctor will remove a small amount of lung tissue and exam it to find out if you have lung cancer and, if so, which type of lung cancer. There are many ways your doctor can remove lung tissue, including a bronchoscopy. In a bronchoscopy, a lighted, flexible tube (bronchoscope) is inserted into your mouth or nose and down into your lungs. This allows your doctor to look for any masses and obtain tissue to biopsy.
What are some lung cancer treatment options?
Your cancer care team will choose a treatment plan based on the type, location, and stage of cancer, your overall health, and your preferences.
Lung cancer surgery to remove the tumor is the first-line treatment for early-stage NSCLC. It gives you the best opportunity to cure the disease. Surgery is only used for NSCLC patients with stage I, stage II, and some stage IIIA lung cancers. It is rarely used as the main treatment for SCLC.
Surgery by a thoracic surgeon may involve the removal of a small tumor and a small portion of healthy tissue (wedge resection), removal of an entire lobe containing the tumor (lobectomy), or removal of an entire lung (pneumonectomy). A lobectomy is the most commonly performed operation if you have healthy lung function.
Radiation treatment uses high-energy rays or charged particles to kill cancer cells and shrink tumors. It is administered by a radiation oncologist alone or in combination with other therapies to treat all stages of NSCLC and SCLC. It is used before surgery to shrink tumors, after surgery to kill any missed cancer cells, and treat cancer that’s spread to other parts of the body. For advanced cases of NSCLC, radiation therapy is used as palliative care to reduce symptoms such as pain and bleeding.
Medications are commonly used as adjuvant therapy with surgery or radiation. Some standard treatments that are used to stop the growth of your cancer include:
- Chemotherapy. Chemotherapy drugs can shrink tumors, reduce your symptoms, and extend your life. They are typically given by an intravenous infusion or taken by mouth. It is used in combination with other therapies before surgery, after surgery, and as palliative care. It is also helpful to treat cancer that has spread to other parts of your body and can’t be surgically removed. Chemo is not often used in patients who are in poor health. Some commonly used chemo drugs include Platinol AQ (cisplatin), Paraplatin (carboplatin), Taxol (paclitaxel), and Taxotere (docetaxel).
- Immunotherapy. These biological medications block proteins in your immune system to help boost your body’s ability to recognize and attack cancer cells. All of these medications can be used in NSCLC and 2 can be used in SCLC. Examples include Opdivo (nivolumab), Keytruda (pembrolizumab), and Libtayo (cemiplimab).
- Targeted therapy. Targeted therapy is directed towards specific abnormalities in the tumor. Your doctor might order biomarker testing (also known as a mutation, genomic, or molecular testing) of your tumor to determine if this therapy should be part of your treatment plan. It is usually used in advanced-stage NSCLC. Some examples include Tarceva (erlotinib), Gilotrif (afatinib), Xalkori (crizotinib), and Alecensa (alectinib).
What is the best medication for lung cancer?
The best medication for the treatment of lung cancer will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with lung cancer medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter lung cancer medications approved by the Food and Drug Administration (FDA).
Best medications for lung cancer
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Libtayo (cemiplimab)||Monoclonal antibody||Injection||350mg via IV infusion every 3 weeks.||Fatigue, rash, diarrhea, joint pain, nausea, cough, itching, anemia|
|Keytruda (pembrolizumab)||Monoclonal antibody||Injection||200mg via IV infusion every 3 weeks or 400mg every 6 weeks.||Loss of appetite, nausea, constipation, vomiting, cough, joint pain|
|Opdivo (nivolumab)||Monoclonal antibody||Injection||240mg via IV infusion every 2 weeks or 480mg every 4 weeks.||Fatigue, shortness of breath, cough, joint and muscle pain, nausea, vomiting|
|Imfinzi (durvalumab)||Monoclonal antibody||Injection||10mg/kg of body weight via IV infusion every 2 weeks or 1500mg every 4 weeks.||High blood sugar, cough, elevated liver enzymes, fatigue, infections, diarrhea, rash|
|Yervoy (ipilimumab)||Monoclonal antibody||Injection||1mg/kg of body weight via IV infusion every 6 weeks.||Fatigue, diarrhea, itching, rash, hepatitis, colitis|
|Avastin(bevacizumab)||Antiangiogenic agent||Injection||15mg/kg of body weight via IV infusion every 3 weeks.||Fatigue, nausea, joint pain, diarrhea, headache, shortness of breath|
|Platinol AQ (cisplatin)||Antineoplastic||Injection||100mg/m2 via IV infusion every 4 weeks.||Nausea, vomiting, kidney damage, hair loss, hearing loss|
|Paraplatin (carboplatin)||Antineoplastic||Injection||360mg/m2 via IV infusion every 4 weeks.||Low white blood cell count, nausea, vomiting, anemia, hair loss|
|Taxol (paclitaxel)||Taxane antineoplastic||Injection||135mg/m2 via 24-hour IV infusion every 3 weeks.||Low white blood cell count, nausea, vomiting, anemia, hair loss, diarrhea, joint pain|
|Taxotere (docetaxel)||Taxane antineoplastic||Injection||75mg/m2 via 1-hour IV infusion every 3 weeks.||Hair loss, anemia, low white blood cell count, muscle weakness, infections, nausea, vomiting|
|Tarceva (erlotinib)||Tyrosine kinase inhibitor||Oral||1 tablet (150mg) once daily 1 hour before or 2 hours after meals.||Rash, weight loss, diarrhea, fatigue, nausea, infection, vomiting, cough|
|Alecensa (alectinib)||Tyrosine kinase inhibitor||Oral||1 tablet (150mg) once daily 1 hour before or 2 hours after meals.||Rash, weight loss, diarrhea, fatigue, nausea, infection, vomiting, cough|
|Xalkori (crizotinib)||Tyrosine kinase inhibitor||Oral||1 capsule (250mg) twice daily.||Vision disorders, diarrhea, vomiting, swelling, constipation, fatigue, infections|
|Lumakras (sotorasib)||KRAS inhibitor||Oral||8 tablets (960mg) once daily.||Decreased hemoglobin, diarrhea, elevated liver enzymes, joint and muscle pain, low calcium, nausea|
|Portrazza (necitumumab)||EGFR inhibitor||Injection||800mg via 1-hour IV infusion on days 1 and 8 of each 3-week cycle.||Low calcium, potassium, and magnesium, rash, vomiting, diarrhea|
|Vizimpro (dacomitinib)||EGFR inhibitor||Oral||1 tablet (45mg) once daily.||Diarrhea, rash, anemia, high blood sugar, decreased appetite, nail infection|
|Tafinlar (dabrafenib)||BRAF kinase inhibitor||Oral||2 capsules (150mg) twice daily.||High blood sugar, headache, joint pain, hair loss, rash, cough, constipation|
Your healthcare provider will determine the right dosage based on your response to the treatment, stage of lung cancer, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of lung cancer medications?
As with all medicines, those used for lung cancer will have some side effects, depending on the class you are taking:
- Chemotherapy medications can cause you to have low white blood cell counts which increases your risk of infections. Some other common side effects include nausea, vomiting, hair loss, anemia, fatigue, muscle pain, headache, and joint pain.
- Immunotherapy drugs can commonly cause joint and muscle pain, fatigue, rash, diarrhea, cough, nausea, vomiting, constipation, and itching.
- Targeted therapy medications can cause fatigue, nausea, joint and muscle pain, diarrhea, headache, high blood sugar, and decreased levels of electrolytes.
What are some home remedies for lung cancer?
There are no natural or home remedies to treat lung cancer. Medications, surgery, and radiation are the treatments you will need for this condition. After completing treatment, it’s still very important to go to all of your follow-up appointments.
You should get screened if you are at a high risk of developing lung cancer. Early detection and treatment will increase your chances of long-term survival. There are several lifestyle changes and self-care measures that may decrease your risk of lung cancer, including:
- Quit smoking
- Avoid secondhand smoke
- Avoid exposure to radon
- Eat a healthy diet high in fruits and vegetables
- Exercise regularly as tolerated
Frequently asked questions about lung cancer
What causes lung cancer?
Smoking causes approximately 90% of lung cancer cases. Some other factors that increase your risk include exposure to secondhand smoke, exposure to radon, family history of lung cancer, radiation therapy to your chest, certain chemical exposure, and air pollution.
What are some early warning signs of lung cancer?
Only 16% of people with lung cancer are diagnosed in the early stages. Contact your doctor right away if you are experiencing a cough that won’t go away, coughing up blood, wheezing, shortness of breath, bone pain, chest pain, and any unexplained weight loss.
Can lung cancer be cured?
Early detection and treatment with medications, surgery and radiation increase your chances of curing this disease.
Who should be screened for lung cancer?
According to the American Cancer Society, yearly lung cancer screening should be for people at a high risk of developing lung cancer that meets all of the following conditions:
- Are between 55 to 74 years old
- Currently smoke or have quit in the past 15 years
- Have at least a 30-pack-year smoking history (for example 1 pack a day for 30 years or 2 packs a day for 15 years)
What is the survival rate for lung cancer?
Lung cancer type and how advanced the disease will affect your survival rate. For NSCLC, those with localized tumors have a 64% chance of surviving 5 years, while cancer that’s spread only has an 8% survival rate. For SCLC, localized tumors have a 29% chance of surviving 5 years, while metastasized cancer only has a 3% survival rate.
Are there any new treatments or clinical trials for lung cancer?
Cancer research is always ongoing, looking for new treatment options. Go to https://clinicaltrials.lungevity.org/ to explore over 1100 current clinical trials in the U.S. to improve your quality of life.
Related resources for lung cancer
- Pathophysiology of lung cancer. StatPearls – National Library of Medicine
- What is lung cancer? Centers for Disease Control and Prevention
- Lung cancer overview. MayoClinic
- Lung cancer basics. American Lung Association
- Lung cancer symptoms and causes. Cleveland Clinic
- What is lung cancer? American Cancer Society