How Chemotherapy for Lung Cancer Works

Chemotherapy for lung cancer is used for different purposes depending on the type and stage of cancer you have. This includes achieving cancer remission, shrinking a tumor before surgery, killing remaining cancer cells after surgery, or relieving lung cancer symptoms when the disease cannot be treated.

Chemotherapy ("chemo") is generally given in a series of intravenous (IV) infusions, known as a cycle, either on its own or with other treatments. Although chemo drugs can help cure or control cancer, they can cause side effects, many of which can be managed with medications and dietary or lifestyle changes.

How Chemotherapy Works for Lung Cancer

Chemotherapy is a form of cancer treatment that employs drugs that are cytotoxic (meaning poisonous to cells). They act specifically on fast-replicating cells like cancer cells, targeting and destroying their DNA and preventing cellular division (mitosis). This action helps shrink tumors or eliminate them completely.

Chemotherapy for lung cancer is typically given intravenously (into a vein) over several hours. The IV infusions are delivered in cycles lasting three to four weeks. Depending on the type of cancer you have and the drugs selected, chemotherapy may be given once during each cycle or, in some cases, weekly.

The aim of chemo can differ depending on the lung cancer type and stage. These are referred to as:

• Induction chemotherapy: This is the first-line use of chemo drugs for curative purposes.
• Neoadjuvant chemotherapy: This helps shrink a tumor to make it easier to remove with surgery.
• Adjuvant chemotherapy: This is used to clear any leftover cancer cells after surgery.
• Consolidation chemotherapy: This is used after remission of a locally advanced tumor to prevent recurrence.
• Maintenance chemotherapy: This is used when remission is not achievable in order to prevent disease progression.
• Palliative chemotherapy: This helps shrink a tumor to reduce symptoms when cancer is not curable.

Chemotherapy may be used on its own or in combination with surgery, radiation therapy, or immunotherapy.

Methods of Chemo Delivery

Because chemo for lung cancer requires multiple IV infusions, implanted devices are commonly used to avoid the repeated insertion and removal of needles from veins.

These include different appliances known as central venous access devices (CVADs), the most common of which include:

• Chemo port: This is a quarter-sized device placed under the skin of the upper chest that has a port to insert the IV needle. A small tube connects the port to a large vein serving the heart, called the superior vena cava.
• Peripherally inserted central catheter (PICC) line: This is a small tube placed in the upper arm that is threaded through a vein in the arm to the superior vena cava.
• Central venous catheter (CVC): This is identical to a PICC line, except that it is placed in the chest or neck.
  

Types of Chemotherapy Drugs Used

There are two main types of lung cancer, called non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Each is treated differently with chemotherapy.

Non-Small Cell Lung Cancer

Non-small cell lung cancer (NSCLC) accounts for roughly 85% of all lung cancers. While not everyone with NSCLC needs chemotherapy, it is generally used for each of the four stages of NSCLC (Stages 1 through 4) as follows:

• Adjuvant therapy for stage 1 NSCLC, sometimes followed by radiation
• Neoadjuvant therapy for stage 2 NSCLC, often accompanied by lymph node removal
• Treatment of locally advanced stage 3 NSCLC, usually with radiation or immunotherapy
• Palliative therapy for advanced stage 4 NSCLC when cancer has spread (metastasized)

Chemotherapy drugs commonly used for NSCLC include:

• Cisplatin
• Carboplatin
  
• Abraxane (albumin-bound paclitaxel)
• Alimta (pemetrexed)
• Gemzar (gemcitabine)
• Navelbine (vinorelbine)
• Taxol (paclitaxel)
  
• Taxotere (docetaxel)
  
• VP-16 (etoposide)
  

For early-stage NSCLC, two chemotherapy drugs are commonly prescribed, one of which would include either cisplatin or carboplatin (known as the "platinum drugs").

For advanced NSCLC, only one chemo drug may be used, especially for people in poor health, who are elderly, or who are unable to tolerate combination therapy.

Small-Cell Lung Cancer

Small-cell lung cancer (SCLC) is a less common form of lung cancer, accounting for around 15% of all cases. It differs from NSCLC in that it has usually metastasized by the time it is diagnosed. Because of this, SCLC only has two stages: limited-stage SCLC and extensive-stage SCLC.

For SCLC, chemotherapy is usually prescribed as follows:

• For limited-stage SCLC, chemotherapy is typically used with radiation.
• For extensive-stage SCLC, chemotherapy may be used with or without immunotherapy and sometimes radiation.

SCLC is generally treated with a combination of chemo drugs, most commonly:

• Cisplatin and Vepesid (etoposide)
• Carboplatin and Vepesid (etoposide)

If SCLC recurs or does not respond to these first-line drugs, other drugs may be used (usually by themselves), including:

• Camptosar (irinotecan)
  
• Gemzar (gemcitabine)
• Hycamtin (topotecan)
• Navelbine (vinorelbine)
  
• Taxol (paclitaxel)
• Taxotere (docetaxel)
• Temodar (temozolomide)
  
• Zepzelca (lurbinectedin)

Side Effects of Chemotherapy

Chemotherapy works by targeting fast-replicating cells. This not only includes cancer cells but also cells in bone marrow, hair follicles, and the digestive tract. The side effects of chemotherapy are primarily caused by damage sustained by these normal cells.

Different people respond to chemotherapy differently, with some experiencing minimal side effects and others developing intolerant side effects.

The most common include:

• Fatigue
• Nausea and vomiting
• Mouth sores
  
• Loss of appetite
• Pain with swallowing
• Constipation or diarrhea
• Hair loss
• Skin and fingernail changes
• Easy bruising or bleeding
• Changes in taste
  
• Changes in memory, thinking, or focus
• Peripheral neuropathy (pins-and-needles sensations)
• Loss of libido
• Sexual dysfunction
• Increased risk of infection
  

Coping With Chemotherapy

Chemotherapy is often portrayed on TV and in films as a terrible ordeal to endure, and that's simply not the case. Today, there are numerous ways to cope with side effects and maintain a quality of life while on treatment.

Some of the more useful tips include the following:

• Get plenty of rest: Even if you are feeling well, it's important to conserve energy by taking regular naps and breaks and cutting back on your workload. With chemotherapy, fatigue can suddenly strike and make treatment harder to endure.
• Stay well hydrated: If you experience diarrhea and vomiting with chemo, drink plenty of water to avoid dehydration which can deplete energy levels and make side effects worse.
• Eat when you can: Nausea, mouth sores, changes in taste, and a loss of appetite caused by chemo can lead to malnutrition if you don't make an effort to eat. Eat smaller meals whenever you can, focusing on bland, nutrient-rich foods that are easy on the stomach.
• Prepare for possible hair loss: Hair loss can be emotionally taxing for people undergoing chemo and preparing for it can help you better cope. This may include cutting your hair short, shaving your head, or trying out wigs, scarves, or hats. There are also head-cooling devices that may help.
• Seek treatment: Your oncologist can prescribe medications to help you cope with chemo side effects. These include antiemetic drugs to treat nausea and vomiting, antidiarrheals to stem diarrhea, and drugs like gabapentin to treat peripheral neuropathy.
• Seek support: Chemotherapy can cause stress and anxiety that can make treatment harder to ensure. To better cope, join an in-person or online cancer support group. If you are unable to cope, do not hesitate to ask for a referral to a counselor or psychiatrist who can help.
  

Prognosis

The prognosis (predicted outlook) for lung cancer is improving every year with earlier detection and newer, more effective treatments extending life expectancy and survival times.

According to updated data from the National Cancer Institute (NCI), people diagnosed with lung cancer today have a five-year survival rate of 26.7%. This means that roughly three of every 10 people with lung will live for at least five years following their diagnosis.

The rate can be far better or worse depending on how early or advanced the cancer is. NCI statistics from 2024 break this down as follows:

• Localized (Stage 1 to 2): 59%
• Regional (Stage 3): 31.7%
• Distant (Stage 4): 5.8%

The survival rate is not a hard and fast rule. The NCI statistics are based on all people with lung cancer, irrespective of age, general health, cancer type, treatment, or co-existing medical conditions (such as heart disease, obesity, or diabetes).

As such, someone who is younger and healthier may stand a far better chance of long-term survival than someone who is elderly or in poor health. At the same time, someone who is healthy and has a strong performance status (meaning the ability to care for themselves) is more likely to withstand aggressive cancer treatments than someone who is frail.

For this reason, survival rates should only serve as a general guideline as to how long you may live with lung cancer.

Summary

Chemotherapy for lung cancer involves one or more drugs given intravenously that can help shrink tumors before surgery, clear remaining cancer cells after surgery, slow tumor progression, or reduce symptoms if a cure is not possible. Remission is also possible with early-stage cancer.

The choice of drugs can vary based on your cancer stage and whether you have non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). Side effects like fatigue, nausea, hair loss, skin changes, and peripheral neuropathy are common but can often be managed with medications and/or changes in diet or lifestyle.