Chemotherapy for lung cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

You might have chemotherapy for small cell lung cancer and non small cell lung cancer. 

When you have it

Small cell lung cancer

Chemotherapy is the main treatment for small cell lung cancer. Doctors use it because this type of cancer responds well to chemotherapy. And small cell lung cancer tends to have spread beyond the lung when it is diagnosed.

Chemotherapy drugs circulate in the bloodstream around the body. So, they can treat cells that have broken away from the lung tumour and spread to other parts of the body.

On its own

You might have chemotherapy on its own to treat small cell lung cancer.

Before, after or with radiotherapy

You might have chemotherapy before or after radiotherapy or at the same time as radiotherapy.

Before or after surgery

If you are going to have surgery for very early small cell lung cancer, your doctor might suggest that you have chemotherapy before or after your operation.

With immunotherapy

You might have chemotherapy with immunotherapy for small cell lung cancer with extensive disease.

Non small cell lung cancer (NSCLC)

Chemotherapy is a common treatment for early and metastatic non small cell lung cancer.

Before or after surgery

Some people might have chemotherapy or chemotherapy in combination with immunotherapy before surgery (neo-adjuvant treatment). This can shrink the cancer and make it easier to remove.

For early stage NSCLC, chemotherapy after surgery (adjuvant chemotherapy) can help to lower the risk of the cancer coming back. If your cancer has a high amount of checkpoint protein PD-L1 (more than 50%), your doctor may recommend immunotherapy after your adjuvant chemotherapy. If your lung cancer tests positive for the EGFR gene change (mutation), your doctor may recommend further treatment with the targeted drug Osimertinib after your adjuvant chemotherapy.

It is important that your doctor talks to you beforehand about the benefits and possible risks of chemotherapy, immunotherapy or Osimertinib after surgery. The drugs can cause side effects. Chemotherapy and immunotherapy tend to work best in fit patients. If you are fit enough to have chemotherapy and immunotherapy. You usually start it within 8 weeks of having surgery.

Before, after or with radical radiotherapy

Giving chemotherapy before or after radiotherapy can sometimes help to get rid of early stage NSCLC in people who can’t have surgery.

If you are fairly fit, your doctor might suggest combined treatment with radical radiotherapy and chemotherapy (concurrent chemoradiotherapy). This will be followed by immunotherapy.

Metastatic (advanced) cancer 

You might have chemotherapy or immunotherapy or both if you have lung cancer that has spread or if you have locally advanced non small cell lung cancer. This will depend on:

• how fit you are
• the amount of checkpoint proteins PD-L1 on your cancer cells

These treatments can relieve symptoms. It can also control the cancer and improve your quality of life for a time, but it can’t cure the cancer.

Your doctor will talk to you in detail about the possible risks and benefits of these treatments. These treatments won’t help everybody. It will depend on how fit you are, and how well you can cope with any side effects.

Types of chemotherapy

Treatment for small cell lung cancer is different to non small cell lung cancer.

Small cell lung cancer

Limited disease

You usually have a combination of chemotherapy drugs, including either cisplatin or carboplatin. Combinations include:

• EP (cisplatin and etoposide)
• carboplatin and etoposide

Extensive disease

You usually have a combination of chemotherapy drugs, including either cisplatin or carboplatin, with an immunotherapy drug:

• carboplatin and etoposide with atezolizumab or durvalumab
• cisplatin and etoposide with durvalumab

Small cell lung cancer usually responds well to these treatments. But researchers are continuing to test other combinations to see if they can either improve the results, lessen the side effects, or both.

If your cancer comes back

If your cancer comes back, you might have further treatment. Some treatments might be as part of a trial. Possible treatment options include:

• carboplatin and etoposide
• cyclophosphamide, doxorubicin and vincristine (CAV)
• topotecan
• lurbinectedin
• paclitaxel
• temozolomide
• irinotecan
• gemcitabine with or without carboplatin

Non small cell lung cancer

You are most likely to have cisplatin or carboplatin with at least one other chemotherapy drug such as:

• pemetrexed
• vinorelbine
• gemcitabine
• paclitaxel (Taxol)
• docetaxel (Taxotere)

You might have the above drugs with immunotherapy or a targeted cancer drug. What treatment combination you’ll have can depend on your cancer stage and any gene changes your cancer might have.

Your doctor will tell you more about what treatment would work best for you.

Metastatic non small cell lung cancer

You might have chemotherapy with immunotherapy for metastatic non small cell lung cancer. You might have one of the following:

• carboplatin or cisplatin with pemetrexed and pembrolizumab
• carboplatin and paclitaxel and bevacizumab and atezolizumab
• carboplatin and paclitaxel and atezolizumab
• carboplatin and paclitaxel and pembrolizumab

You might also have chemotherapy for metastatic lung cancer if you are well enough but can’t have immunotherapy or targeted cancer drugs.

You might have carboplatin or cisplatin with one of the following:

• gemcitabine
• paclitaxel
• docetaxel
• vinorelbine

Or you might have on of the following:

• carboplatin and paclitaxel
• cisplatin and pemetrexed
• pemetrexed
• cisplatin, pemetrexed and bevacizumab
• carboplatin, pemetrexed and bevacizumab

Check the name of the chemotherapy treatment with your doctor or nurse, then find out about it on our A to Z list of cancer drugs.

How you have chemotherapy

You have most of these drugs into your bloodstream but some are capsules that you swallow.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.

Taking your tablets

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

Treatment cycles

You take some cancer medicines in treatment cycles. This means you take the drug for a set period, followed by a break. For example, you might take a drug every day for a week and then not take it for 2 weeks. This 3 week period in total is one cycle of treatment.

Take your cancer drugs exactly as your doctor, specialist nurse or pharmacist has told you to. The break from treatment is important too. For many cancer drugs, it allows your body to recover.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

Side effects

Common chemotherapy side effects include:

• feeling sick
• loss of appetite
• losing weight
• feeling very tired
• increased risk of getting an infection
• bleeding and bruising easily
• diarrhoea or constipation
• hair loss

Side effects depend on:

• which drugs you have
• how much of each drug you have
• how you react

Tell your treatment team about any side effects that you have.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

• take any supplements
• have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

When you go home

Chemotherapy for lung cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.