Lung Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy, or chemo, uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

When might chemotherapy be used for lung cancer? 

Not everyone with lung cancer needs chemotherapy. But it is part of the standard treatment for most people. Whether you need chemo, and what type of chemo you need, will depend mainly on these factors:

• The kind of lung cancer you have. Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are treated differently.

• The stage (extent) of the cancer

• Whether the cancer cells have certain gene changes (for NSCLC)

• The goal of treatment

• Your age and general health

• Concerns you have about side effects

• What treatments you have had in the past (if any)

Your healthcare provider may recommend chemo for the following cases.

Small cell lung cancer

Chemo is part of the recommended treatment for all people with SCLC if they are healthy enough to tolerate it. It may be used along with radiation therapy (sometimes after surgery) for limited stage SCLC. It may be given by itself or along with radiation for more advanced (extensive stage) SCLC.

Non-small cell lung cancer

Your doctor may recommend chemo to treat NSCLC in these cases:

• If you have NSCLC that has not yet spread to distant parts of the body, you may get chemotherapy before surgery. Chemo may be given alone or with radiation. This is to try to shrink the tumor to make surgery easier. This is called neoadjuvant therapy. 

• You may have chemo after surgery to help make sure all the cancer cells are killed. You may have chemo alone or with radiation therapy. This is known as adjuvant chemotherapy.

• You may have chemo as your main treatment if you have cancer that has not spread but can't be removed with surgery. You may also have it as your main treatment if you are not healthy enough for surgery.

• If you have advanced NSCLC, chemotherapy is often used to try to shrink the cancer or keep it under control for as long as possible. This can also often help ease symptoms such as coughing or bone pain.

How is chemotherapy given for lung cancer?

Before treatment starts, you will meet with a medical oncologist. This is a doctor with special training to treat cancer with medicines such as chemotherapy. The doctor will discuss your treatment choices with you and tell you what you might expect. 

Chemotherapy for lung cancer is typically given through a tube (catheter) with a small needle that has been put into a vein. The medicine usually drips in slowly over several hours.

You usually get chemotherapy as an outpatient. That means that you get it at a hospital, clinic, or healthcare provider's office. You can go home after the treatment is given. Less often, you may need to stay in the hospital during treatment. You'll be watched for reactions during your treatments. Chemotherapy sessions may last for many hours, so you may want to take along something that is comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

To reduce the damage to healthy cells and to give them a chance to recover, chemotherapy is given in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest. Cycles typically last 3 to 4 weeks. Most people get 4 to 6 cycles as part of their initial treatment. Treatment usually lasts for several months. Your healthcare provider will discuss your chemotherapy schedule with you.

What medicines are used to treat lung cancer?

These are some common chemo medicines used to treat lung cancer. They are listed in alphabetical order, not based on how often they are used.

• Albumin-bound paclitaxel (nab-paclitaxel)

• Cisplatin

• Carboplatin

• Docetaxel

• Etoposide

• Gemcitabine

• Irinotecan

• Paclitaxel

• Pemetrexed

• Vinorelbine

Two of these medicines are often combined as the first treatment. For people who are not healthy enough to get 2 medicines or for people who have already had chemo for their lung cancer, one medicine might be used instead.

What are common side effects of chemotherapy?

Side effects of chemotherapy are different for each person. They vary based on the medicines you get. Below are some of the most common side effects from chemotherapy for lung cancer. Ask your doctor or chemotherapy nurse for details about the side effects for the medicine you are getting.

• Hair loss. If you have hair loss, the hair will usually grow back after the treatment stops.

• Nausea and vomiting. This side effect can be usually controlled with medicines. Ask your healthcare provider about it.

• Mouth sores. Chemo can sometimes cause mouth sores. These might make it hard for you to eat or swallow. It's important to keep your mouth very clean and avoid foods and substances that could irritate your mouth.

• Diarrhea. If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.

• Loss of appetite or changes in the way things taste. Talk with your healthcare provider if you find you are having trouble eating or are losing weight. He or she can often offer suggestions.

• Increased risk for infection. During your chemo treatments, your white blood cell count may become low. This means your immune system won’t be working as well as it usually does. It’s a good idea for you to avoid people who have illnesses that you could catch. It’s also a good idea to take extra precautions against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Be sure to let your doctor or nurse know if you have any signs of possible infection, such as a fever, sore throat, a new cough, or burning during urination.

• Bleeding and bruising more easily. Chemo can also lower your blood platelet counts. You need platelets to help the blood clot as it should. 

• Fatigue. You may feel tired while getting chemotherapy. This usually goes away once treatment ends. 

Some other side effects can also be seen with certain chemo medicines. For example, cisplatin and carboplatin can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in the hands and feet. 

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemotherapy can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.