Lung Cancer Treatment Options

Lung cancer treatment starts with a basic split. About 8 in 10 lung cancers are non-small cell lung cancer, or NSCLC. It is treated with surgery, radiation, and drug therapy. Often more than one is combined. Small cell lung cancer is less common. It grows faster. It is treated mainly with chemotherapy and radiation from the start. That is because it has usually spread by the time it is found. This article focuses on NSCLC, the more common type.

Within NSCLC, treatment depends mainly on stage. It also depends on your lung function, overall health, and specific traits of the tumor found through testing.

Early-stage NSCLC is usually treated with surgery. The preferred operation is called a lobectomy. It removes an entire lobe of the lung, along with nearby lymph nodes. For some stage I cancers at higher risk of returning, doctors may add more treatment after surgery. This can include chemotherapy, immunotherapy, or targeted therapy, to lower that risk. This is called adjuvant treatment, meaning it comes after the main treatment. Which drugs are added depends on tumor testing results, discussed below.

Stage III NSCLC has grown locally advanced, often reaching nearby lymph nodes, but has not spread to distant organs. Treatment here usually combines more than one approach.

Some stage IIIA cancers can still be removed with surgery. Sometimes chemotherapy or radiation shrinks the tumor first. Most stage IIIB and IIIC cancers cannot be safely operated on. For these, chemotherapy and radiation are given together, called chemoradiation. Afterward, doctors often give an immunotherapy drug called durvalumab for up to a year. Doctors call this consolidation treatment. It lowers the chance the cancer returns or spreads. For tumors with an EGFR mutation, a targeted drug called osimertinib may be used instead in this consolidation period.

Once NSCLC has spread to distant organs, treatment shifts to drugs that reach the whole body. Before choosing them, your tumor is tested for specific gene changes: EGFR, ALK, ROS1, BRAF, RET, MET, KRAS, and NTRK are the ones checked most often.

If your tumor carries one of these changes, doctors usually try a targeted therapy pill first. It is aimed at that specific change. These drugs block the exact signal driving that tumor's growth. They often work better than chemotherapy. They also tend to cause different side effects.

If no targetable change is found, doctors check a separate marker called PD-L1. It sits on the surface of some tumor cells. Immunotherapy drugs called checkpoint inhibitors release the brakes your immune system normally has on itself. That lets it attack the cancer. These are often combined with chemotherapy, especially when PD-L1 levels are low. Chemotherapy alone or combined with immunotherapy remains the backbone treatment when no targetable change or high PD-L1 level is found.

Skipping tumor testing can mean missing a targeted drug. That drug might have worked better, with fewer side effects, than starting chemotherapy right away. This is why oncologists usually wait for biomarker results, when reasonably possible. They want those results before finalizing a stage IV treatment plan. Ask directly whether your tumor has been tested and for which genes.

• What is the exact stage of my cancer, and is surgery part of the plan?
• Has my tumor been tested for EGFR, ALK, ROS1, and other gene changes? What about PD-L1?
• If a targeted therapy or immunotherapy applies to me, how does it compare to chemotherapy for side effects?
• Will I need treatment after surgery or after chemoradiation to lower the risk of recurrence?
• Is a clinical trial a reasonable option for me?

• American Cancer Society — Treating Non-Small Cell Lung Cancer
• American Cancer Society — Treatment Choices for Non-Small Cell Lung Cancer, by Stage