Lung cancer treatment can involve several approaches depending on the cancer type, stage, genetic changes, overall health, and treatment goals. Options may include surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, or combinations of these treatments. Biomarker testing can help identify treatments that may be appropriate for some non small cell lung cancers. This guide explains common treatment approaches, medication categories, factors that influence treatment decisions, possible side effects, and questions patients can discuss with their cancer care team.
Lung cancer is not a single disease, and treatment plans can differ considerably from one person to another. The two major categories are non small cell lung cancer and small cell lung cancer. Doctors consider the cancer type, stage, location, whether it has spread, biomarker results, and the person's general health when developing a treatment plan. Some people receive one treatment, while others receive several treatments in combination.
How Lung Cancer Treatment Is Selected
Treatment planning usually begins with diagnostic testing and staging. For some people with non small cell lung cancer, biomarker testing can identify genetic changes or other features that may influence medication choices. The treatment goal may be to remove or control the cancer, slow its growth, reduce symptoms, or improve quality of life.
Common factors considered include:
- Type of lung cancer
- Stage and location of the cancer
- Whether the cancer has spread
- Biomarker and molecular test results
- Overall health and other medical conditions
- Previous cancer treatment
- Potential treatment benefits and side effects
- Individual treatment goals and preferences
Treatment Options at a Glance
| Treatment approach | How it is generally used | Key consideration |
|---|---|---|
| Surgery | Removes cancer from the lung or nearby tissue | More commonly considered when cancer can be removed |
| Radiation therapy | Uses high energy radiation to damage cancer cells | May be used alone or with other treatments |
| Chemotherapy | Uses medicines that kill or slow rapidly growing cancer cells | Can be combined with other treatments |
| Immunotherapy | Helps the immune system recognize and fight cancer | Eligibility can depend on cancer characteristics |
| Targeted therapy | Acts on specific changes that help cancer cells grow | Biomarker testing is important for selecting certain therapies |
These approaches may be used individually or together depending on the situation.
How Surgery and Radiation Therapy May Help
Surgery can be an important option when a lung tumor can be removed safely. Depending on the cancer and the person's circumstances, procedures may involve removing part of a lung or a larger portion. Early stage non small cell lung cancer may be treated with surgery in appropriate patients.
Radiation therapy uses high doses of radiation to damage cancer cells and shrink tumors. It can be used before or after other treatments, or as an important treatment by itself in certain situations. Radiation may also be used to help relieve symptoms caused by cancer.
Important points include:
- Surgery is generally considered when cancer can be removed.
- Radiation may be used when surgery is not appropriate.
- Stereotactic body radiation therapy may be an option for some early stage cancers.
- Radiation can sometimes be combined with chemotherapy.
- Treatment schedules depend on the cancer and the intended treatment goal.
How Lung Cancer Medications Work
Medication-based treatment can include chemotherapy, immunotherapy, and targeted therapy. Chemotherapy uses drugs that kill cancer cells or stop the growth of rapidly dividing cells. It may be used before or after surgery, together with radiation, or for advanced disease.
Immunotherapy works differently by helping the immune system fight cancer. Several immunotherapy medicines are used for certain forms of non small cell lung cancer, including pembrolizumab, nivolumab, atezolizumab, durvalumab, cemiplimab, ipilimumab, and tremelimumab. Whether a particular medicine is appropriate depends on the cancer and individual clinical factors.
Targeted therapy focuses on specific proteins or molecular changes that help cancer cells grow, divide, or spread. Examples of medicines used for particular non small cell lung cancers include osimertinib, alectinib, lorlatinib, sotorasib, tepotinib, selpercatinib, and other targeted medicines. The appropriate medication depends on the specific biomarker identified.
Why Biomarker Testing Can Matter
Biomarker testing can provide information about genetic changes or other characteristics within a tumor. This information can help doctors determine whether certain targeted therapies or immunotherapy approaches may be suitable. NCI notes that biomarker testing can help guide treatment decisions, particularly in non small cell lung cancer.
Examples of factors that may be evaluated include:
- EGFR alterations
- ALK changes
- ROS1 alterations
- MET changes
- RET alterations
- KRAS changes
- BRAF changes
- PD L1 expression
Not every patient will have these biomarkers, and the presence of a biomarker does not automatically mean that a particular medication is appropriate. Test results need to be interpreted alongside the cancer stage and other clinical information.
How Side Effects Are Considered
Cancer treatments can cause side effects, although the type and severity vary between treatments and individuals. Chemotherapy can affect rapidly growing healthy cells, while immunotherapy can sometimes cause the immune system to affect healthy tissues. Targeted therapies can also produce treatment-specific side effects.
Patients can discuss:
- Which side effects are common
- Which symptoms require prompt medical attention
- How side effects can be managed
- Whether medicines or supportive care can help
- How treatment may affect daily activities
- When follow-up testing will be performed
How Treatment May Change Over Time
Lung cancer treatment is not always a single course. A doctor may adjust treatment depending on how the cancer responds, whether side effects occur, and whether the disease changes over time. For advanced non small cell lung cancer, treatment can include chemotherapy, targeted therapy, immunotherapy, or combinations depending on individual factors.
Clinical trials may also provide access to treatments that are being studied. Research continues to evaluate newer targeted therapies, immunotherapies, combinations, and other approaches for different stages of lung cancer.
Conclusion
Understanding lung cancer treatment options can make medical discussions easier. Surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy all have different roles, and combinations may be appropriate depending on the cancer. Biomarker testing can be particularly important when considering targeted medicines for non small cell lung cancer. Because treatment decisions depend on individual medical circumstances, patients should discuss test results, medication choices, potential benefits, side effects, and treatment goals with their qualified cancer care team.