Which Lung Cancer Medications Are Currently Used for Treatment?

According to the American Cancer Society, lung cancer, both small cell lung cancer, and non-small cell lung cancer is the second most common cancer in both men and women. The 2021 estimates for lung cancer are 235,760 new cases and 131,880 deaths from lung cancer. The majority of patients get diagnosed with lung cancer at the age of 65 years or older, and it is by far the leading cause of cancer death among both men and women.

Lung cancer characteristics:

Types of lung cancer are divided into two subgroups: Small cell lung cancer (SCLC) that makes up for 25% of lung cancers, and non-small cell lung cancer (NSCLC) that is responsible for the remaining 75% of lung cancer, which include squamous cell carcinoma, large cell carcinoma, bronchoalveolar, and bronchoalveolar cell carcinoma.

The number one risk factor of lung cancer is smoking cigarettes, which accounts for at least 85% of cases. Consequently, second-hand smoke is also a risk factor for lung cancer. Another risk factor for lung cancer is exposure to asbestos, a naturally occurring fibrous silicate mineral that is common in shipbuilding, the construction industry, car mechanics, and painting. As a result, the combination of smoking and asbestos increases a person’s chance of developing lung cancer substantially.

Staging of lung cancer is different between small cell lung cancer and-non small cell lung cancer. NSCLC is staged via the TNM system – T describes the original tumor, N indicates whether the cancer has spread to the nearby lymph nodes, and M tells whether the cancer has spread, or metastasized to other distant parts of the body.

Treatment of lung cancer:

1. What is used to treat non-small cell lung cancer (NSCLC)?

Surgery is the best option, unless the patient has metastatic disease outside of the chest.
Radiation therapy is an important adjunct to surgery

Chemotherapy is of uncertain benefits. More trials are underway.

2. What is used to treat small cell lung cancer (SCLC)?

For limited disease, chemotherapy drugs and radiation therapy are recommended initially.
For extensive disease, chemotherapy is used alone as the initial treatment. Prophylactic radiation has been proven to decrease the risk of brain metastasis and prolong patient survival rates.
Surgery has almost no role here because these tumors are usually nonresectable.

The comprehensive list of drugs that are approved for NSCLC and SCLC by the FDA can be found here: https://www.cancer.gov/about-cancer/treatment/drugs/lung

Chemotherapy

Chemotherapeutic regimens are designed for synergism, meaning drugs with different mechanisms of action are chosen to complement each other to fight cancer. Most of these drugs are effective at killing rapidly dividing cancer cells by interfering with the DNA replication cycle. Common lung cancer regimens can be a single drug regimen or a combination of two to three drugs given together. Some of the common drugs are below:

Chemotherapy drugs can be highly toxic because non-cancerous cells in bone marrow, the gastrointestinal tract, and hair follicles are being destroyed along with the cancerous cells. Adverse effects of chemotherapy and their severity vary among patients due to age, sex, medical history, and the dose being used. Though, patients will generally experience myelosuppression (low number of blood cell counts), nausea, vomiting, diarrhea, loss of appetite, fatigue, hair loss, and being immunosuppressed that leads to increased risk of infection.

Targeted therapy

Targeted therapies, as the name indicates, targets the specific cancer gene proteins. These medications work to inhibit the growth of cancerous cells with minimal damage to healthy cells. Targeted therapies for NSCLC include:

1. Epidermal growth factor receptor (EGFR) inhibitors: EGFR inhibitors are effective in treating lung cancer if the cancer cells have EGFR mutations.

Osimertinib (Tagrisso)
Erlotinib (Tarceva)
Afatinib (Gilotrif)
Dacomitinib (Vizimpro)
Gefitinib (Iressa)

2. Anaplastic lymphoma kinase (ALK) inhibitors: mutation of ALK facilitates the cancerous cell growth process. Inhibiting ALK will stop the growth of cancerous cells.

Alectinib (Alecensa)
Brigatinib (Alunbrig)
Ceritinib (Zykadia)
Crizotinib (Xalkori)
Lorlatinib (Lorbrena)

3. ROS1 targeting drugs: mutation of the ROS1 gene is rare and it can cause problems with cell growth. The following drugs target changes to the ROS1 gene:

Crizotinib (Xalkori)
Entrectinib (Rozlytrek)

Monoclonal antibodies

Monoclonal antibodies work via different mechanisms to inhibit cancer cell growth. Some of them bind to a specific antigen or receptors and destroy cancer cells, while others activate the immune system to recognize and destroy cancer cells. A lot of patients with advanced NSCLC are treated with monoclonal antibodies combining with lung cancer chemotherapy drugs. Most adverse effects are infusion-related reactions, hypotension, skin rash, flu-like symptoms, and bronchospasm. Severe side effects are less common compared to chemotherapy.

Atezolizumab (Tecentriq)
Cemiplimab (Libtayo)
Durvalumab (Imfinzi)
Nivolumab (Opdivo)
Pembrolizumab (Keytruda)

Improvement in quality of life for lung cancer patients

With today’s advanced technology and research, cancer patients have a better chance of beating their illness and prolonging survival. However, these medications come with physical symptoms such as nausea, vomiting, fatigue, and hair loss, leading to emotional and financial distress for the patients and their loved ones. That’s why palliative care or supportive care is an essential part of the care plan. Palliative care is the management of all the effects of cancer treatment. Palliative care includes medications, nutritional support, therapies, non-medication pain management, and spiritual and emotional guidance. Examples of palliative care for lung cancer patients include:

Pain medications with morphine being a commonly used agent. Pain medications relieve pain while reducing shortness of breath caused by pain and anxiety.
Cough medication is used to open airways and reduce secretions.
Steroids such as methylprednisolone or prednisone are used to reduce inflammation caused by cancer or radiation therapy.
Extra oxygen supplements are used to alleviate shortness of breath.
Medications and supplements are prescribed to strengthen bones and prevent bone loss.
Appetite stimulants and nutritional supplements.

Discussing the treatment plan and expectations with your doctor and the care team before starting cancer treatment is very important. As mentioned above, treating lung cancer patients or any cancer, in general, requires a multifaceted approach. The care team would include the oncologist, pain specialist, pharmacist, nursing staff, home health agency, and spiritual counselor. Discussion of the treatment plan upfront will allow the patients and family to learn about the process while addressing any concerns or questions that they may have.

Lung cancer awareness

Lung cancer is a leading cause of cancer death in both men and women in the United States. Please educate yourself and others on lung cancer screening and prevention, as early detection is vital for optimal prognosis and survival.

Lung cancer screening and prevention

For high-risk individuals, lung cancer screening with a CT scan can reduce the risk of death from lung cancer. High-risk individuals are defined as:

People who are between the ages of 50 and 80
In addition to a history of 20 pack-years of cigarette use or more, and continue to smoke or have quit within the past 15 years

Please talk to your primary care physician for more details on lung cancer screening if you have more questions regarding risks due to exposure and occupation.

The most important step to reduce the risk of lung cancer is to quit smoking and check for radon in the home. Radon is an odorless, colorless gas that is the number one cause of lung cancer in non-smokers. Maintaining a healthy lifestyle and weight by regular exercising is strongly encouraged for everyone. Incorporating plenty of fruits and vegetables in your diet while limiting alcohol intake also promotes overall good health.

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