Chemotherapy for Lung Cancer

Chemotherapy as a cancer treatment option is commonly mentioned in the media and by medical professionals as a way to combat the disease. But what exactly is chemotherapy, and how does it apply to lung cancer patients? This article will delve deeper into chemotherapy and its specific application to lung cancer patients.

Chemotherapy is a type of systemic treatment that aims to kill fast-growing cells. It does so by targeting dividing cells in various stages of growth. This means that it can potentially harm both cancerous and healthy cells. Therefore, it is important to understand the potential side effects and benefits associated with chemotherapy treatment before starting lung cancer treatment.

To treat lung cancer, doctors prescribe chemotherapy

• In combination with other therapy (radiation therapy or immunotherapy) to
  • Delay tumor resistance
  • Improve treatment outcomes by targeting different aspects of cancer progression
  • Kill the cancer cells before they turn aggressive and spread
• As adjuvant therapy following radiation therapy and surgery
• As neoadjuvant therapy, in combination with immunotherapy or radiation therapy – given before surgery to shrink the tumor and make surgery easier
• Based on performance status (ability to perform day-to-day activities) - Older or frail patients with a poor performance score (performance score >2) may not benefit from chemotherapy, while experiencing the toxic effects from treatments
• As palliative care – chemotherapy may reduce the size of a tumor that is causing symptoms like pain or shortness of breath
• As maintenance therapy – to delay cancer relapse for as long as possible

Cisplatin is the first platinum-based anticancer drug invented. It was discovered in the late 1960s for its anti-proliferative (inhibition of cell division and growth) effect on bacterial growth. Platinum is also toxic to proliferating human cells. Carboplatin is another example of a platinum drug.

Platinum-based drugs often give good initial therapeutic responses, like

• Tumor shrinking
• Disease stabilization

However, these drugs have several downsides:

• Severe side effects due to toxicity, especially on kidney, hair follicles and neural system
• Development of tumor resistance to the platinum-based drug

1. The drugs used in chemoimmunotherapy are called immune checkpoint inhibitors. These drugs recognize PD-1/PD-L1 or CTL4A (types of surface protein) on cancer cells and stimulate the immune system to target them.

Cancer cells can sometimes evade killing by the immune system. Some chemotherapeutic agents induce immunogenic cell death, a type of cell death that releases signals that activate the immune system. When cancer cells die in this manner, they release signals that attract immune cells and help them recognize and attack the remaining cancer cells.

The effectiveness of combining chemotherapy and immunotherapy may vary depending on the type of cancer, the specific drugs used, and the patient's individual circumstances. The choice of treatment regimen and timing should be determined by your cancer care team based on your condition and the available treatment options. One of the factors that affect treatment options is performance status.

Performance status is a measurement of your ability to perform day-to-day activities. It helps doctors determine

• how well a patient is able to carry out daily activities
• and thus how capable they are of withstanding the physical and emotional demands of cancer treatment

Performance status is particularly important when making treatment decisions and predicting a patient's prognosis.

The Eastern Cooperative Oncology Group (ECOG) Performance Status Scale assigns a numerical value from 0 to 5, with 0 being the fittest and 5 being dead.

Doctors use this scale to assess a patient's performance status during diagnosis, before starting treatment, and at regular intervals during the course of treatment. It helps guide treatment decisions by considering factors such as whether the patient can tolerate aggressive therapies like surgery, chemotherapy, or radiation or if more conservative or palliative care options are more appropriate.

When cancer has been stabilized (no additional growth or spreading), chemotherapy is often continued to extend the progression-free period, thereby extending cancer patients’ lifespan.

After cycles of chemotherapy, doctors will assess the cancer's remission status. Patients may drop other drugs and stay with one medicine from the initial chemotherapy if the results are good and stable. This is called maintenance therapy.

Related: Maintenance Therapy in Lung Cancer: Who, What, Why, When, How

The American Lung Association has prepared a helpful video on what to expect from chemotherapy and how to prepare yourself.