HEALTH INSIGHTS

Lung Cancer: Targeted Therapy

June 21, 2018

Lung Cancer: Targeted Therapy

What is targeted therapy?

Targeted therapy uses medicines that target specific parts of cancer cells that help the cancer grow and spread. Targeted medicines can sometimes be more helpful than standard chemotherapy (chemo) medicines. And because targeted medicines often focus more on the cancer cells, they may cause less harm to normal cells. That may mean they don't cause as many side effects. 

When might targeted therapy be used for lung cancer?

Targeted therapy can be used to treat some people with advanced forms of non-small cell lung cancer (NSCLC). Many targeted therapy medicines are only helpful for people whose cancer cells have certain gene changes. So if you have advanced NSCLC, your doctor will likely want lab tests done on your cancer cells to see if they have any of these gene changes. Some targeted therapy medicines are used alone. Others are given along with chemotherapy.

So far, no targeted therapy medicines have been shown to help treat small cell lung cancer (SCLC).

Types of targeted therapy for lung cancer

EGFR inhibitors

Some targeted therapy medicines aim for a protein on cells called the epidermal growth factor receptor (EGFR). Many types of cancer cells make too many of these growth factor receptors. This helps them grow. Medicines that target and block EGFR may be used to treat advanced NSCLC.

Some of these medicines can be used instead of chemo if the lung cancer cells have certain changes (mutations) in the EGFR gene:

  • Erlotinib

  • Afatinib

  • Gefitinib

  • Osimertinib

These medicines are taken as pills.

Necitumumab is an EGFR inhibitor that can be used in people with the squamous cell subtype of NSCLC. It can be used even if the cancer cells don’t have EGFR mutations. This medicine is given by IV (intravenous line) into a vein.

Angiogenesis inhibitors

Some medicines used in NSCLC target new blood vessel growth, known as angiogenesis. Tumors need new blood vessels to grow. So blocking new blood vessels with these medicines may help keep them from growing. These medicines are often used along with chemotherapy for more advanced NSCLC:

  • Bevacizumab

  • Ramucirumab

These medicines are given by IV into a vein.

ALK inhibitors

About 5% of NSCLCs have changes in the ALK gene that help them grow. Medicines that target the ALK protein can often be helpful against these cancers instead of chemo. ALK inhibitors include:

  • Crizotinib

  • Ceritinib

  • Alectinib

  • Brigatinib

These medicines are taken as pills.

Possible side effects of targeted therapy

You may have side effects from your treatment. The possible side effects can vary a great deal depending on which medicine you are getting. 

Side effects of EGFR inhibitors can include: 

  • Acne-like rash on the face and chest

  • Nausea

  • Mouth sores

  • Diarrhea

Common side effects of angiogenesis inhibitors include:

  • High blood pressure

  • Feeling tired

  • Mouth sores

  • Loss of appetite

  • Diarrhea

  • Headache

  • Bleeding

  • Low white blood cell counts. (This means you have a higher risk for infections).

These medicines can also cause a number of less common but more serious side effects. They include:

  • Serious bleeding

  • Blood clots

  • Holes in the intestines

  • Heart problems

  • Slow wound healing

Common side effects of ALK inhibitors can include:

  • Nausea

  • Diarrhea

  • Constipation

  • Feeling tired

  • Eye problems or vision changes

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. Tell them about any changes you notice so they can help you control them. Most side effects can be treated, and there may be ways to keep them from getting worse.

Talk with your healthcare providers about what signs to look for and when to call them. 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. 

Updated:  

June 21, 2018

Sources:  

NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer Ver 2.2018 -- Dec 19, 2017, National Comprehensive Cancer Network

Reviewed By:  

Gersten, Todd, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS