Treatments for stage 3 non–small cell lung cancer
Chemotherapy and external radiation therapy may be given together before surgery for stage 3 non–small cell lung cancer. You need to be well enough to have this treatment. Chemoradiation may also be given if you won't be having surgery and are well enough to have this treatment.
The chemotherapy drug combinations most often used with chemoradiation are cisplatin with etoposide (Vepesid).
Surgery may be offered after chemoradiation if the chemoradiation shrinks the tumour enough to make removing it possible.
A lobectomy removes the lobe of the lung where the tumour is. A bilobectomy is a type of lobectomy that removes 2 of the 3 lobes of the right lung.
A sleeve resection removes a tumour from one of the airway tubes of the lung (the bronchi) along with a margin of healthy tissue around the tumour.
A pneumonectomy removes the whole lung.
An extended pulmonary resection removes the muscles, nerves, blood vessels and other tissues near the lung. During the surgery, a wide area of tissue surrounding the lung is taken out to remove as much of the cancer as possible. Surgery for cancer that has grown into the bones of the spine is done using 2 surgeries, one to support the spine with rods followed by another surgery to remove the tumour.
A chest wall resection removes the muscles, bones and other tissues of the
For stage 3A non–small cell lung cancer, you may be offered surgery after chemoradiation if the cancer has responded to chemoradiation. You need to be healthy enough to have surgery.
For stage 3B and 3C non–small cell lung cancer, you will not be offered surgery because surgery will not help given where the cancer has spread. You will be offered other treatments.
The chemotherapy drug combinations that may be used to treat non−small cell lung cancer are:
cisplatin with vinorelbine or etoposide – most common 2 combinations
cisplatin (or carboplatin) and gemcitabine
cisplatin (or carboplatin) and docetaxel (Taxotere)
carboplatin (or cisplatin) and paclitaxel
gemcitabine and docetaxel
gemcitabine and vinorelbine
carboplatin (or cisplatin) and pemetrexed (Alimta) – not used for squamous cell carcinoma of the lung
For stage 3A non–small cell lung cancer, you may have chemotherapy before surgery if you cannot be given radiation therapy. Chemotherapy may also be given after surgery if no chemotherapy was given before surgery or if the cancer responded to chemotherapy given before surgery.
For stage 3B and 3C non–small cell lung cancer, you may have chemotherapy by itself if you are not well enough to have chemoradiation or radiation therapy.
Targeted therapy @(Model.HeadingTag)>
Targeted therapy may be used to treat stage 3 non−small cell lung cancer. The type of targeted therapy you have will depend on the type of genetic change (mutation) found during diagnosis using cell and tissue studies and whether there is treatment based on that mutation.
EGFR targeted therapy @(Model.HeadingTag)>
Epidermal growth factor receptor (EGFR) is a receptor on the surface of cells that sends signals to cells that allow them to grow and divide. A mutation in the EGFR gene can cause cancer cells to grow and divide more than normal. Cancer cells that have the EGFR mutation are called EGFR positive (EGFR+).
EGFR-positive stage 3B and 3C non−small cell lung cancer may be treated with targeted therapy instead of chemotherapy. Drugs that may be used are:
Erlotinib may also be given as
ALK targeted therapy @(Model.HeadingTag)>
Anaplastic lymphoma kinase (ALK) is a protein that helps with cell growth and division. It is controlled by the ALK gene. A very small number of non–small cell lung cancers have a change (mutation) in the ALK gene. Cancer cells that have the ALK mutation are called ALK positive (ALK+).
ALK-positive stage 3 non−small cell lung cancer may be treated with crizotinib (Xalkori). If you can't take crizotinib, other drugs that may be given are:
ROS1 targeted therapy @(Model.HeadingTag)>
The ROS1 gene makes a protein that is responsible for signals in cells and helps with cell growth. A mutation in the ROS1 gene can cause cancer cells to grow and divide more than normal. Cancer cells that have the ROS1 mutation are called ROS1 positive (ROS1+).
ROS1-positive stage 3 non−small cell lung cancer may be treated with crizotinib.
Entrectinib (Rozlytrek) may be offered for ROS1-positive stage 3 non–small cell lung cancer, if you have not been given crizotinib as a treatment.
Angiogenesis inhibitors @(Model.HeadingTag)>
Bevacizumab (Avastin, MVASI, Zirabev) is a type of targeted therapy called an
Different types of immunotherapy may be used to treat stage 3 non−small cell lung cancer.
Necitumumab (Portrazza) is a type of
Durvalumab (Imfinzi) is a PD-L1 checkpoint inhibitor. If you can't have surgery, you may be given durvalumab to treat stage 3 non–small cell lung cancer that has stopped growing when it has been treated with chemoradiation. Durvalumab is given until the cancer starts to progress (grow again).
Radiation therapy @(Model.HeadingTag)>
External radiation therapy by itself may be given as the main treatment if you have stage 3 non–small cell lung cancer and are not well enough to have surgery, chemotherapy or chemoradiation as treatment.
External radiation therapy may be delivered by 3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT).
Clinical trials @(Model.HeadingTag)>
Talk to your doctor about clinical trials open to people with non−small cell lung cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.
Stephen Lam, MD, FRCPC
Osmani L, Askin F, Gabrielson E, Li QK. Current WHO guidelines and the critical role of immunohistochemical markers in the subclassification of non-small cell lung carcinoma (NSCLC): moving from targeted therapy to immunotherapy. Seminars in Cancer Biology. 52(Pt 1): 103-109.
Dong J, Li B, Lin D, Zhou Q, Huang D. Advances in targeted therapy and immunotherapy for non–small cell lung cancer based on accurate molecular typing. Frontiers in Pharmacology. 2019: 10:230.
Sui H, Ningxia M, Wang Y, Li H, Xiaoming L, Su Y, Yang J. Anti-PD1/PD-L1 therapy for non-small cell lung cancer: toward personalized medicine and combination strategies. Journal of Immunology Research. 2018: 2018: 6984948.
Cancer Care Ontario. Non-small Cell Lung Cancer Treatment Pathway Map. 2019: Version 2019.05.
Chiang A, Detterbeck FC, Stewart T, Decker RH, Tanoue L. Non–small cell lung cancer. DeVita VT Jr, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 48:618–670.
Brahmer JR, Covindan R, Anders RA, Antonia SJ, Sagorksy S, et al. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of non-small cell lung cancer (NSCLC). Journal for ImmunoTherapy of Cancer. 2018: 6:75.
National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer (Version 3.2020) . 2020 .