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. Read more about these recommendations on the ASCO website. Chemotherapy is often not as effective as radiation therapy or surgery to treat NSCLC that has spread to the brain. For this reason, NSCLC that has spread to the brain is usually treated with radiation therapy, surgery, or both.
This can cause side effects such as hair loss, fatigue, and redness of the scalp. With a small tumor, a type of radiation therapy called stereotactic radiosurgery can focus the radiation only on the tumor in the brain and lessen the side effects.
Newer targeted therapies, such as osimertinib and alectinib, have shown that they can work well to treat brain metastases. In addition, immunotherapy may also be an option. This may allow many patients to have a systemic therapy for brain metastases and avoid the side effects that come from chemotherapy and radiation therapy to the brain.
As described above, palliative care will also be important to help relieve symptoms and side effects. Radiation therapy or surgery may also be used to treat metastases that are causing pain or other symptoms. Bone metastases that weaken major bones can be treated with surgery, and the bones can be reinforced using metal implants. For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team.
It may also be helpful to talk with other patients, including through a support group. A remission is when cancer cannot be detected in the body and there are no symptoms. A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Non-small cell lung cancer. National Comprehensive Cancer Network. Accessed Jan. Non-small cell lung cancer adult. Mayo Clinic; Small cell lung cancer. Niederhuber JE, et al. Cancer of the lung: Non-small cell lung cancer and small cell lung cancer. In: Abeloff's Clinical Oncology. Elsevier; Small cell lung cancer adult. Lung cancer prevention PDQ. National Cancer Institute. Accessed March 14, Lung cancer — non-small cell: Screening.
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Warner KJ. Allscripts EPSi. Mayo Clinic. Cairns LM. Managing breathlessness in patients with lung cancer. Nursing Standard. World Health Organization. Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine. Dong H, et al. B7-H1, a third member of the B7 family, co-stimulates T-cell proliferation and interleukin secretion. Nature Medicine. Searching for cancer centers. American College of Surgeons. Dunning J, et al. Microlobectomy: A novel form of endoscopic lobectomy.
Aberle DR, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. Brown AY. July 30, Still, they're not right for everyone. If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few. Complementary methods refer to treatments that are used along with your regular medical care. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work.
Some might even be harmful. Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known or not known about the method, which can help you make an informed decision. People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care. Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms.
If you have lung cancer especially non-small cell lung cancer , your doctor may run tests external icon to find out if you have a change in your genes genetic mutation. The results of these tests help your doctor know which treatments will work best for you. If lung cancer is diagnosed, other tests are done to find out how far it has spread through the lungs, lymph nodes, and the rest of the body.
This process is called staging. The type and stage of lung cancer tells doctors what kind of treatment you need. Lung cancer is treated in several ways, depending on the type of lung cancer and how far it has spread.
People with non-small cell lung cancer can be treated with surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of these treatments. People with small cell lung cancer are usually treated with radiation therapy and chemotherapy. Doctors from different specialties often work together to treat lung cancer. Pulmonologists are doctors who are experts in diseases of the lungs.
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