Comparing Chemotherapy, Targeted Therapy, and Immunotherapy
When a lung cancer patient will not be cured through surgery or radiotherapy, drug intervention becomes necessary. People often think this automatically means the patient will go on chemotherapy, but there is often confusion about what this really means. After all, there are different types of chemotherapy, and more recently new categories of treatment have become commonplace, including targeted therapy and immunotherapy. Briefly, here is a comparison of these options and a look at some concerns regarding these forms of extended treatment.
Comparing treatment costs
While hospital care of any kind is expensive, with surgery and radiation it is often easy to understand the costs and what insurance covers. The costs of drug-based treatments differ dramatically based upon how and where the drug is administered, the cost of the drug itself, and what the health-insurance company's coverage includes. Most insurance, whether government policies like Medicare or Medicaid or private policies purchased through exchanges or an employer, will cover most expenses related to these therapies. The cost-sharing may be different for targeted drugs than for chemotherapy, and many drug companies offer assistance directly to the patient to help cover higher out-of-pocket costs, so it is important for patients to get this information up front in order to avoid unpleasant surprises. Sometimes an insurance company might initially deny any coverage for a new drug and then, upon appeal, cover the entire cost of treatment. If a patient has access to a nurse navigator, such a professional can help to get the answers a patient needs. Otherwise, many clinics have special offices for financial assistance.
Chemotherapy is a class of drugs designed to destroy cancer at the cellular level. While various chemo drugs are administered in different ways, some as pills taken at home and some as infusions a patient must receive in a clinical setting, most work by addressing the mechanism by which cells divide. Chemotherapies are designed to attack cells that divide and reproduce very quickly, a trait that leads to the rapid growth of cancer tumors but also is common in some healthy cells involved in hair and nail growth or intestinal lining. This is one reason that many cancer patients experience hair loss, though not all chemotherapies will affect normally functioning hair cells. Chemotherapy works well when the cancer cells are readily disrupted during division, effectively killing them off and reducing or eliminating the tumor presence.
Unlike chemotherapy drugs, targeted therapies work on specific aspects unique to cancer cells. For this reason, they are often much easier for patients to tolerate, though they do have their own range of side effects. Targeted cancer drugs may work by addressing specific mutations that are found in some types of cancer cells, or otherwise take advantage of genetic abnormalities. They might also affect a specific process regarding ways that cancer cells operate by binding to different proteins or genes in the tumor cells. Because of the narrow and unique nature of how targeted therapies work, only patients who demonstrate the required mutations would benefit from them. Genetic tests are often routinely done to check for actionable mutations, and this is an area in which patients should consult with their oncologist prior to the start of treatment and again before any change in treatment. Even if a full molecular or genetic panel had been done earlier, sometimes new mutations develop over time and sometimes new drugs enter the market that target mutations that already existed without a previous treatment.
Immunotherapy is one of the most exciting areas of treatment that has entered the mainstream in recent years. While not all patients are responsive to immunotherapies, those who do respond often have amazing results. While immunotherapy is still a young form of treatment, it is being tested in conjunction with other therapies to see if there are ways of making it viable for a wider range of patients. Often it is only likely to work if patients exhibit certain types of protein markers or gene mutations in their cancer cells. Essentially, immunotherapies utilize the patient's own immune system to attack the cancer cells by making the cancer cells become visible to the patient's T-cells, which then treat the cancer cells like foreign invaders rather than the normal tissue they otherwise appear to be.
As research evolves, new combined approaches are being tested. These may include using immunotherapy, chemotherapy and targeted therapies concurrently or in sequence. And while no one drug or approach is the answer for every patient, the variety and efficacy of therapeutic options continues to expand, offering more and better solutions for the complex and ever-unique issues of lung cancer treatment.1-4
Editor’s Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.
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