All Cancers Lung Cancer Treatment & Recovery

First-Line Treatments for Lung Cancer

Medically Reviewed by Jun Zhang, MD, PhD

Written by J. GuanJan 2, 20247 min read

Source: Shutterstock

First-line treatment or initial treatment refers to the first planned treatment that is carefully tailored to your diagnosis with the goal of delivering the best possible outcomes. This article focuses on what to expect during first-line treatments for both non-small cell and small cell lung cancer. The information below provides comfort and reassurance as you navigate through your treatment journey for lung cancer.

First-line treatment for non-small cell lung cancer (NSCLC)

Surgery is the best approach for early-stage patients who are medically operable. Patients who are

older and frail
with high comorbidities (existence of other chronic health conditions)
those who do not want to have surgery

can consider radiation therapy as a primary alternative to surgery.

First-line treatments for NSCLC.

Stage	Operable or resectable	Medical inoperable
1	Surgical resection alone Surgical resection, followed by adjuvant therapy: targeted therapy for EGFR-positive and ALK-positive patients chemotherapy	Radiation alone
2	Surgical resection alone Surgical resection, followed by adjuvant therapy: Chemotherapy Chemotherapy and targeted therapy for EGFR-positive and ALK-positive patients Chemoradiation Immunotherapy Chemo- or chemoimmunotherapy (neoadjuvant), followed by surgical resection	Radiation alone Radiation, followed by adjuvant chemotherapy or immunotherapy
3	Surgical resection, followed by adjuvant therapy: Chemotherapy Chemotherapy and targeted therapy for EGFR-positive and ALK-positive patients Radiation Chemoradiation Immunotherapy Chemotherapy (neoadjuvant), followed by surgical resection Chemoradiation (neoadjuvant), followed by surgical resection Chemoimmunotherapy (neoadjuvant), followed by surgical resection	Radiation alone Radiation, followed by adjuvant chemotherapy Radiation, followed by adjuvant immunotherapy Chemoradiation Chemoradiation, followed by adjuvant immunotherapy
4	Usually not an option May be considered for patients with oligometastasis on a case-by-case scenario, followed by adjuvant therapies	Combination of chemotherapeutic drugs Chemotherapy combined with targeted therapy Targeted therapy Immunotherapy

Data source: The National Cancer Comprehensive Network (NCCN)

Chemotherapy and immunotherapy are systemic therapies that treat cancer cells anywhere in the body. Sometimes, doctors may start patients on chemotherapy while waiting for molecular test results. If a driver mutation is found,

you may stop your current treatment early and start targeted therapy
finish your current treatment and then start targeted therapy

First-line treatment for small cell lung cancer (SCLC)

The SCLC can still be staged using a two-stage system: limited and extensive. Surgical resection may still be considered for limited-stage patients with small primary tumor that have no evident involvement of any lymph node and metastasis.

First-line treatment for SCLC

Stage	First-line treatment
Limited	Surgical resection, followed by adjuvant therapy: Chemotherapy Chemoradiation Combination of chemotherapeutic drugs Chemoradiation, and maintained with immunotherapy (pending FDA approval)
Extensive	Chemotherapy alone Combination of chemo- and immunotherapy Radiation to reduce symptoms (palliative), followed by chemo- and/or immunotherapy

Data source: The National Cancer Comprehensive Network (NCCN)

Reresection

After the initial surgery, doctors may observe the patient for any residual tumor activity. A second resection or reresection may be arranged based on the surgical observations and lab assessment of the biopsied tumor if needed.

When first-line treatment no longer works

Under these circumstances, the first-line treatment may not be effective, and a different therapy or a second-line treatment has to be planned:

Insensitivity/not responding – every individual is different. Some people may not respond to certain drugs as well as other patients
Severe side effects from a particular drug – remedies are available to relieve the side effects of chemo- and immunotherapeutic drugs. But some people may react more strongly (life-threatening complications) to drug toxicity that the treatment must be terminated immediately
When the tumor becomes resistant to the initial treatment
Cancer recurrence/relapse – often occurs when resistance happens

The treatment journey is challenging for many, and it is important to remember that first-line treatment may not always be effective. While this can be disheartening, do take things one step at a time. Each step of the way may bring unexpected outcomes. It is natural to feel even more apprehensive about what lies ahead. However, find solace in the healthcare team, as they are highly experienced and knowledgeable. Voice out any concerns and doubts about the treatment plan with them. They are there to support patients and provide all the necessary information to make informed decisions.

Glossary

Adjuvant therapy: treatment given after primary therapy to slow down cancer relapse or recurrence

Neoadjuvant therapy: treatment given before primary therapy (usually surgery), with the aim of shrinking the tumor