Chemotherapy treatment for lung cancer

Chemotherapy means using anti cancer (cytotoxic) drugs to destroy cancer cells. These work by disrupting the growth of cancer cells. 

Small cell lung cancer (SCLC)

Chemotherapy is the main treatment for small cell lung cancer. Doctors use it because this type of cancer responds very 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 or after 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.

Non small cell lung cancer (NSCLC)

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

Before or after surgery

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

For early stage NSCLC, chemotherapy after surgery can help to lower the risk of the cancer coming back. It is important that your doctor talks to you beforehand about the benefits and possible risks of chemotherapy. The drugs can cause side effects. Chemotherapy tends to work best in patients who are fit. If you are fit enough to have chemotherapy, you usually start it within about 8 weeks of having surgery.

Before, after, or alongside radiotherapy treatment

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 radiotherapy and chemotherapy (chemoradiotherapy).

Advanced cancer

You might have chemotherapy if you have lung cancer that has spread or if you have locally advanced non small cell lung cancer. It can help some people to live longer even if their cancer can’t be cured.

Types of chemotherapy

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

Small cell lung cancer

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

• EP (cisplatin and etoposide)
• carboplatin and etoposide
• Gemcarbo (gemcitabine and carboplatin)

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.

Non small cell lung cancer

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

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

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 the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Taking capsules

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.

When you have chemotherapy

You usually have chemotherapy every 3 to 4 weeks if you have it into a vein. Each 3 to 4 week period is called a cycle. You might have between 4 to 6 cycles of chemotherapy.

If you have capsules that you swallow you might have the treatment once a week. Or you might have it once a day for 5 days every 3 weeks.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You’ll sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time.

You have some types of chemotherapy over a couple of days and stay in a hospital ward. But this is not usual with lung cancer chemotherapy.

Before you start chemotherapy

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

Side effects

Common chemotherapy side effects include:

• feeling sick
• loss of appetite
• losing weight
• feeling very tired
• a lower resistance to infections
• 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.

Your team can help you manage any side effects.

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.

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. They could be harmful.