For stage 4 specifically, treatment options include chemotherapy, immunotherapy, radiotherapy, and targeted therapies. The choice of treatment will depend on the type of cancer you have, how advanced it is, your overall condition, and how capable you are of withstanding side effects. Stage 4 lung cancer treatment is aimed at controlling the cancer, such as by slowing its growth, and minimizing symptoms.
Chemotherapy
Stage 4 lung cancer will typically require one or more chemotherapy drugs, either alone or in combination with targeted therapies or immunotherapies. You may also require chemotherapy as maintenance therapy — treatment that you receive to keep the cancer from spreading further.
Chemotherapy is usually administered through an IV; this way, the medication reaches the cancer cells that have spread throughout the body. Chemotherapy drugs commonly used in stage 4 lung cancer include:
- carboplatin (Paraplatin, Carboplatin Novaplus)
- cisplatin (Platinol, Platinol-AQ)
- docetaxel (Taxotere, Docefrez, Docivyx)
- etoposide (VePesid, Etopophos, Toposar)
- gemcitabine (Gemzar, Infugem)
- paclitaxel (Taxol, Onxol)
- pemetrexed (Alimta, Pemfexy, Pemrydi RTU)
- vinorelbine (Navelbine)
If your doctor recommends a combination of chemo drugs, this will likely consist of cisplatin or carboplatin and one other drug. But the choice of chemo drugs depends on many factors, including your overall health and whether you’ve taken the drug before.
Chemotherapy can cause significant side effects, including:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea
- Vomiting
- Unintentional weight loss
- Diarrhea
- Constipation
- Increased likelihood of infections
- Easy bruising
- Bleeding
- Fatigue
Immunotherapy
Immunotherapy is a biological therapy (a therapy that uses compounds made from living organisms) to help your immune system better fight off cancer. Different immunotherapy drugs help the immune system in different ways, be it by enabling it to better identify cancer cells, bind to specific targets on the surface of cancer cells, or mount a stronger response against them.
Immunotherapy drugs typically used to treat stage 4 lung cancer include:
The choice of immunotherapy drug for you and your type of cancer will depend on very specific factors, like the proteins your type of cancer makes, or what genetic mutations it has.
For example, pembrolizumab (Keytruda), blocks the PD-1 receptor, allowing your healthy cells to fight the cancer better. Overexpressing this protein causes your immune system to essentially put the brakes on its cancer-fighting abilities, but the immunotherapy takes these brakes off.
Immunotherapy drugs for lung cancer are usually taken intravenously (through an IV), but some can be injected under the skin (subcutaneously).
Side effects of immunotherapy can range from flu-like symptoms (such as fatigue, fever, and chills) to musculoskeletal pain to heart palpitations. The side effects are often a result of the immunotherapy reactivating the immune system to act against the cancer, but at the same time, attacking healthy cells and tissues in the body.
Targeted Therapy
Targeted therapies get their name from targeting specific proteins that help tumors grow. Some targeted therapies interrupt the chemical signaling that helps the cancer spread, others suppress the hormones that cancer needs to grow, while others yet deliver cancer-killing compounds to cancer cells.
Some targeted therapies boost your immune system’s cancer-fighting abilities, so in that sense, they are also immunotherapies. “Targeted therapies and immunotherapy have been groundbreaking for people with stage 4 lung cancer,” says Dr. Bostock.
To find out which targeted therapy is most suited for your type of cancer, you’ll need to undergo biomarker testing, which may require a biopsy. This is to find out what genes, proteins, or other molecules characterize your cancer (and thus determine the best way to destroy it).
There are many targeted therapies approved for lung cancer. The ones most commonly used for stage 4 in particular include:
The most common side effects of targeted therapies include diarrhea and liver problems.
Surgery
Typically, stage 4 lung cancer isn’t treated with lung surgery, as the tumor has spread beyond the lung. Also, people with advanced lung cancer may not feel well enough to withstand the risks and physical toll of surgical intervention.
Sometimes, though, surgery is effective for stage 4 NSCLC that has spread to the adrenal glands, brain, or liver, by removing tumors that have clustered together in those areas.
Radiotherapy
Radiation therapy, or radiotherapy, is sometimes used to alleviate lung cancer symptoms, or instead of chemo or surgery for people who aren’t well enough for these other interventions.
External beam radiation requires specialized equipment, and you won’t feel a thing while receiving the actual radiation beam. But the treatment can cause side effects, such as fatigue, nausea, breathlessness, hair loss, and appetite loss.
Complementary and Integrative Therapies
During lung cancer treatment, complementary and integrative therapies can help improve comfort, alleviate symptoms, or help a person cope with side effects.
It’s important to remember that complementary therapies don’t cure cancer and they are not alternatives to standard treatments, but they can be beneficial to your physical and mental health.
These complementary therapies may bring you some comfort and relief or help improve your overall health:
- Meditation, mindfulness, and breathing techniques can all help to quiet the mind and manage stress.
- Yoga and tai chi can help balance your mind and body, as well as improve your physical mobility.
- Acupuncture may help relieve the side effects of chemo, such as nausea and vomiting.
- Vitamins, herbs, and dietary supplements may help strengthen your body in the fight against cancer, improve your mood, or ease insomnia or depression.
- Massage therapy, chiropractic care, and reflexology can help ease body pain.
Be mindful that some supplements (like St. John’s wort) or even fruit (like grapefruit and Seville oranges) can interfere with medications or treatments because they contain enzymes that can affect how well your body absorbs the drug.
Always consult your healthcare provider before deciding to try any complementary or integrative therapies.
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