Chemotherapy is used to kill cancer (malignant) cells by targeting rapidly dividing cells. The drugs travel throughout the body, making chemotherapy a systemic treatment that can kill cancer cells anywhere in the body. Chemotherapy drugs are often used in combination, and chemotherapy may be used along with other treatments for lung cancer, such as surgery, radiation therapy, immunotherapy, or targeted therapy. Chemotherapy drugs are also called anti-neoplastic drugs because they are used to help prevent the development, growth or spread of neoplasms (tumors).2-4
Targeted therapies are cancer treatments that block or slow the spread of cancer by interfering with specific areas of cancer cells that are involved in the cancer cell’s growth processes. Chemotherapy focuses on cells that rapidly divide, which includes cancer cells as well as other rapidly dividing cells in the body, like cells in the digestive tract, hair, bone marrow, and blood, causing multiple side effects. Targeted therapy focuses on other identifiable features of cancer cells, in an effort to provide treatment to cancer cells with less effect on normal cells.4,5
Targeted therapy also differs from chemotherapy in the way it affects cancer cells. Targeted therapies are generally cytostatic, meaning they block the proliferation or growth of cancer cells. Chemotherapy drugs are typically cytotoxic, meaning they kill cancer cells. 5 There are different categories of targeted therapies that have been developed to treat non-small cell lung cancer (NSCLC), which are based on the genetic mutations and molecular processes that have been identified in some NSCLC tumors.
Immunotherapy is a type of treatment that aims to boost the body’s own immune system to fight cancer cells. In the immune system, the white blood cells called T-cells are responsible for identifying and destroying cells that have become infected with germs or cells that have mutated and become cancerous. However, cancerous cells can continue to change and can develop ways to suppress the normal T-cell response.6,7
Researchers have begun to identify pathways where cancer cells suppress the T-cell immune response. One of the pathways that is affected in some lung cancers is the PD-1 (programmed cell death) receptor and its ligands (the molecules which bind to the receptor) PD-L1 and PD-L2. When this pathway is exploited by the mutations in the cancerous cells, the cancer can grow and spread without being kept in check by T-cells. Two immunotherapy treatments have been developed to target the PD-1 pathway in NSCLC treatment: Keytruda® (pembrolizumab) and Opdivo® (nivolumab).7
Additional immunotherapies approved for the treatment of certain forms of NSCLC include Tecentriq (atezolizumab) and Imfinzi (durvalumab), both PD-L1 inhibitors, as well as ipilimumab (Yervoy®), a CTLA-4 inhibitor. By blocking CTLA-4, ipilimumab provides another pathway to helping improve T-cell function against the cancer.
For small cell lung cancer (SCLC), Opdivo® (nivolumab) and Keytruda® (pembrolizumab) may be options for some patients where the cancer is metastatic (has spread to other parts of the body) and has gotten worse after receiving platinum based chemotherapy and at least one other form of treatment. Tecentriq® (atezolizumab) and Imfinzi® (durvalumab) can be used in patients with extensive-stage SCLC as first line-treatment in addition to certain chemotherapy drugs.8
Palliative care medications
In addition to these treatments, there are other medications that may be used for palliative care, a specialized field that aims to alleviate symptoms and maximize the patient’s quality of life. Palliative care does not focus on curing the disease or prolonging life, which is the goal of other cancer treatments.
However, palliative care is an important part of the patient’s treatment plan and encompasses physical symptoms, psychosocial distress, spiritual distress, and caregiver distress. Medications used for palliative care include pain reducers, appetite stimulants, anti-nausea drugs, and others.1