Chemotherapy is a treatment with chemicals that kills cells that divide or grow rapidly, like cancer cells. Unfortunately, some normal cells (e.g., the skin, lining of the digestive tract, hair follicles) also rapidly divide and grow. Chemotherapy can also affect those cells and that may cause unwanted side effects.
The kind(s) of chemotherapy your doctor recommends will depend on your individual situation. The type of lung cancer (non-small cell or small cell) you have been diagnosed with, your overall health, the goals of treatment, and your personal preferences will be taken into consideration.
Initial (first line) chemotherapy for lung cancer often includes a “platinum-based” drug such as cisplatin or carboplatin and another drug or drugs such as paclitaxel (Taxol), docetaxel (Taxotere), etoposide (VP-16), gemcitabine (Gemzar) or vinorelbine (Navelbine). Pemetrexed (Alimta) and bevacizumab (Avastin) may also be used instead of or in addition these drugs.
If first line chemotherapy is not decreasing the size of the cancer, or if it continues to grow, other drugs may be used, together or separately. Chemotherapy after the initial round is called second line.
Types of Chemotherapy
Neo-adjuvant chemotherapy is treatment with chemotherapy that is used before another treatment. In lung cancer, it is typically used to try to shrink the tumor so that surgery is possible.
Adjuvant chemotherapy is treatment with chemotherapy that is used after another treatment. In lung cancer, it is typically used with the goal of killing stray cancer cells that may remain after surgery. Chemotherapy is not recommended after surgery for stage IA lung cancer. When lung cancer is stage II or above and can be removed with surgery, chemotherapy is typically recommended. The use of chemotherapy after surgery for stage IB lung cancer remains controversial. Be sure to talk with your doctor about the risks and benefits of adjuvant chemotherapy so that you can make an informed decision.
Maintenance chemotherapy is when chemotherapy is continued after the usual 4-6 cycles (“continuation maintenance”). “Switch maintenance” is when a new drug is given for a longer period after the first treatment cycle is completed. One type of chemotherapy, pemetrexed (Alimta) is approved as maintenance chemotherapy in non-small cell lung cancer but others may be used by your doctor or as part of a clinical trial setting. One targeted drug (erlotinib or Tarceva) is also approved for use as maintenance in non-small cell lung cancer under certain circumstances. Lung cancer specialists do not agree on if and how maintenance chemotherapy should be used.
If lung cancer comes back (recurs) after successful treatment, the same or different chemotherapy may be used, alone or together.