Non-Small Cell Lung Cancer Treatment

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, making up about 85 percent of all lung cancers.¹

NSCLC has several sub-types, classified by the types of cells. Each type grows and spreads in different ways. The classification is determined by looking at the malignant (cancerous) cells under a microscope and is important because classification helps doctors choose appropriate treatment regimens, as well as determine the prognosis or projected outcome of the cancer.

In addition, treatment recommendations for NSCLC are based on the stage of the lung cancer, and the general health of the patient.²

Types of non-small cell lung cancer

Microscopic examination and laboratory tests are used to identify the type of NSCLC. This classification provides doctors with information on the growth characteristics of the malignancy and is one of the factors in developing treatment recommendations.

Types of NSCLC include:¹

• Adenocarcinoma
• Squamous cell carcinoma
• Large cell carcinoma
• Adenosquamous carcinoma
• Sarcomatoid carcinoma
• Carcinoma of salivary gland type

Staging

The staging of NSCLC describes the extent of the disease, including tumor size, lymph node involvement and the spread of the cancer into nearby or distant areas of the body (metastases).²

• Stage I: The tumor is small (between ≤1 to 4 cm) and no lymph nodes are involved. There are no metastases.
• Stage II: The tumor is small (between ≤1 to 7 cm), and there may be cancer in the adjacent lymph nodes. There are no metastases.
• Stage III: The tumor may be small or larger, the adjacent lymph nodes and lymph nodes on the other side of the chest, above the collarbone, or in the neck are often involved. There are no metastases.
• Stage IV: Stage IV includes any size tumor and any amount of lymph node involvement. The main determinant of Stage IV is the presence of metastases elsewhere in the body.

Treatment options

There are several different treatment modalities for NSCLC, although not all treatment options are appropriate for every patient. Treatment options may include:²

• Surgery – removal of the tumor, which may include removing a portion or all of a lung
• Radiation therapy – the use of high-energy rays targeted on the cancer
• Chemotherapy – the use of drugs to kill cancer cells
• Targeted therapy – a class of drugs that focuses on specific genetic mutations present in the tumor cells
• Immunotherapy – a class of drugs that boosts the patient’s immune system to find and destroy cancer cells
• Palliative care – supportive care that does not treat the cancer itself, but aims to improve quality of life and is done concurrently with other treatment
• Complementary medicine – practices which are used in combination with traditional medicine, such as dietary supplements, massage, acupuncture, and hypnosis

Treatment by stage

Treatment options will differ based on the stage and substage of NSCLC, although not all treatment options are appropriate for every patient. These options may include:³

• Stage I NSCLC: Surgery to remove the cancer may be the only treatment needed for stage I NSCLC, as the cancer is localized (contained within the lung). Some lymph nodes will be removed for testing to ensure the cancer has not spread. Depending on the type of NSCLC and its aggressiveness, chemotherapy, immunotherapy, and/or radiation therapy after surgery may also be recommended. In patients who are not good candidates for surgery, radiofrequency ablation (RFA) or stereotactic body radiation therapy (SBRT), also known as SABR (stereotactic ablative radiotherapy), may be options.
• Stage II NSCLC: Patients with stage II NSCLC who are healthy enough for surgery may have surgery to remove the cancer and a sampling of nearby lymph nodes. Additional treatment may include a combination of surgery, chemotherapy, radiation therapy, immunotherapy, and/or targeted therapy.
• Stage IIIA NSCLC: Stage IIIA NSCLC may be treated with a combination of chemotherapy and radiation therapy. For patients who are healthy enough to tolerate it, treatment often begins with chemotherapy. Surgery may be an option for patients who are good candidates and if the doctor believes the tumor can be removed with surgery. Immunotherapy or targeted therapy may be options for certain patients.
• Stage IIIB NSCLC: Stage IIIB NSCLC cannot be removed completely by surgery. Treatment is dependent on the patient’s overall health and may include chemotherapy, radiation, targeted therapy, immunotherapy or a combination of some of these options.
• Stage IV NSCLC: Because stage IV NSCLC has spread to distant sites in the body, they are difficult to cure. Treatment recommendations are based on the extent of the cancer spread as well as the overall health of the patient and may include surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy or a combination of some of these options. Cancers that have spread to only one other site can sometimes be treated with surgery and/or radiation, in addition to the treatment of the primary tumor in the lung.