Chemotherapy for lung cancer

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. Most people with lung cancer have chemotherapy. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is often combined with radiation therapy to treat lung cancer. This is called chemoradiation. The 2 treatments are given during the same time period. You will not be offered chemoradiation if you aren't healthy enough to have this type of treatment.

Chemotherapy is given for different reasons. You may have chemotherapy or chemoradiation:

• to shrink a tumour before other treatments such as surgery (called neoadjuvant therapy)

• to destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant therapy)

• as the main treatment if you aren't well enough to have surgery or for cancer that can't be removed with surgery

• to relieve pain or control the symptoms of advanced lung cancer (called palliative therapy)

• as maintenance therapy in people who have advanced non–small cell lung cancer that has responded to chemotherapy

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the blood to reach and destroy cancer cells all over the body, including those that may have broken away from where the tumour started in the lung.

Lung cancer is usually treated with a combination of 2 drugs, which is more effective than any one drug alone. The drugs chosen will depend mainly on the type of lung cancer you have.

The most common chemotherapy drug combinations used to treat lung cancer include cisplatin as one of the drugs. If you can't have cisplatin because of your health, a related drug called carboplatin may be used instead.

• cisplatin (or carboplatin) and gemcitabine

• cisplatin (or carboplatin) and docetaxel (Taxotere)

• cisplatin and etoposide (Vepesid)

• carboplatin (or cisplatin) and paclitaxel

• gemcitabine and docetaxel

• gemcitabine and vinorelbine

• carboplatin (or cisplatin) and pemetrexed (Alimta) – not used for squamous cell carcinoma or small cell lung cancer

• carboplatin (or cisplatin) and irinotecan – used for small cell lung cancer

If you have advanced or metastatic lung cancer but you can't have combination chemotherapy because of poor health or other medical conditions, single chemotherapy drugs may be used. Single drugs may also be used if combination chemotherapy has stopped working.

The most common single drugs used to treat lung cancer are:

• gemcitabine

• docetaxel

• etoposide

• paclitaxel

• pemetrexed – not used for squamous cell carcinoma or small cell lung cancer

Targeted therapy or immunotherapy drugs may be added to chemotherapy to treat advanced or metastatic lung cancer.

Side effects can happen with any type of treatment for lung cancer, but everyone's experience is different. Some people have many side effects. Other people have only a few side effects.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the combination of drugs, the dose, how it's given, if you have radiation at the same time, and your overall health. Some common side effects of chemotherapy drugs used for lung cancer are:

• low blood cell counts
• nausea and vomiting
• diarrhea
• fatigue
• hair loss
• peripheral nerve damage
• loss of appetite
• sore mouth and throat
• skin problems
• constipation

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.