Lung cancer begins when normal cells in the lungs change and grow uncontrollably, forming a mass called a tumor. There are two major types of lung cancer: non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer (NSCLC) is the most common type. NSCLC and small cell lung cancer are treated in different ways. This guide covers chemotherapy treatment options for people with stage IV NSCLC.

Stage is a way to describe a cancer, such as how much it has grown and whether it has spread to other parts of the body. Lung cancer may spread to the lymph nodes, the tiny, bean-shaped organs that help fight infection, and other parts of the body, specifically the brain, bones, liver, and/or adrenal glands. Stage IV NSCLC has spread to more than one part of the lung or other distant parts of the body. Learn more about lung cancer staging [1] or treatment options for other stages of lung cancer [2].

Chemotherapy for NSCLC

People with stage IV NSCLC usually receive chemotherapy, which is the use of drugs to kill cancer cells. This is the only treatment that will go everywhere in the body and destroy cancer cells wherever they may be located. Chemotherapy has been shown to improve both length of life and quality of life for patients with NSCLC. However, chemotherapy will not get rid of the cancer completely or cure it. The goal of chemotherapy for stage IV NSCLC is to control the disease so that it will stop growing and spreading. Patients must be prepared to take chemotherapy, on and off, for the rest of their lives to maintain control of the disease. Most chemotherapy used for lung cancer is injected into a vein (called intravenous, or IV injection). Other drugs are pills that can be taken by mouth. There are many different drugs, and drug combinations, from which the doctor and patient can choose. The first drug or combination of drugs a patient takes is called “first-line” treatment, which may be followed by “second-line” and “third-line” treatment. People with stage IV NSCLC may also consider a clinical trial [3] or supportive or palliative care (see below).

The side effects of chemotherapy for NSCLC vary widely, depending on the drug or drug combinations and should be discussed with the doctor before starting treatment. Side effects may include fatigue, low blood cell counts, risk of infection, hair loss, rash, mouth sores, nausea and vomiting, loss of appetite, diarrhea, hearing problems, numbness or tingling in the hands and feet, or swelling in the ankles. Learn about managing side effects of cancer treatments [4].

Most types of chemotherapy kill cancer cells by destroying rapidly growing cells, which is why these drugs also affect blood cells and hair cells. Other types of drugs, called targeted therapies, target the cancer's specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. These drugs include bevacizumab (Avastin), cetuximab (Erbitux), and erlotinib (Tarceva), and gefitinib (Iressa; not available in the United States). This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells; however, they may cause side effects, such as high blood pressure or bleeding (bevacizumab), rash (cetuximab, erlotinib, gefitinib), and diarrhea (erlotinib, gefitinib).

No specific treatment or combination of treatments works for every patient. If the first-line treatment causes unpleasant or dangerous side effects, does not appear to be working, or stops working, the doctor may recommend a change in treatment.

Performance Status

When making treatment decisions with patients, doctors evaluate a patient's ability to carry out daily activities using an index (zero [0] through four [4]) called performance status. A performance status rating of 0 or 1 means that a person is able to move around easily, be out of bed for more than half the day, and take care of oneself relatively easily. A person who is strong enough to go about his or her daily activities without assistance, including working outside the home, can typically receive chemotherapy and targeted therapy. A performance status rating of 2 means a person cannot do any work, but can still take care of himself or herself and is out of bed for more than half of the day. A patient's performance status is an important factor in helping the doctor and patient decide on treatment options. For example, doctors may recommend targeted therapy, and rarely chemotherapy, for a person with a performance status of 2. Other illnesses, such as heart disease, emphysema, and diabetes may affect a patient's performance status.

Supportive Care

In addition to treatment to slow or stop the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person's symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care [5]. People often receive disease-directed therapy and treatment to ease symptoms at the same time. Supportive care is always an option for a person with stage IV NSCLC.