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What are the symptoms of non-small cell lung cancer? Read More
What are the available treatment options for NSCLC? Read More
Measures to help relieve symptoms and improve quality of life Read More
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Advanced Non‐Squamous Non–Small Cell Lung Cancer

Treatment Management

What are the available treatment options for NSCLC?

One’s medical history and result of tests on general health helps the doctor determine the best possible treatment regimen every time.

Doctors devise treatment strategies based on a thorough understanding of various factors. This forms part of the treatment planning process. The said factors include medical history of the patient, results of physical examination that includes blood tests, imaging tests (PET/CT, MRI of brain, thorax and spine), airway tests, lung function tests, biopsy and laboratory tests for molecular biomarkers.

Available treatment options for NSCLC include :

I. Surgery

Surgery, along with other treatments may be an option for early stage NSCLC. This however may not help if the disease is in an advanced stage. Based on the size and spread of the tumour as well as patient’s health, the doctor may advise for pneumonectomy (removal of entire lung), lobectomy (removal of one or more lobes of the lung), segmentectomy/wedge resection (removal of a part of the lobe) or a sleeve resection (in case of cancers in the large airways). Surgery is generally done through a surgical incision between the ribs in the side of the chest (thoracotomy) and is often accompanied with removal of nearby lymph nodes to look for possible spread of cancer.

Lately, physicians have also considered use of video-assisted thoracic surgery (VATS), which requires smaller incisions than thoracotomy.

II. Radiofrequency ablation (RFA)

RFA uses high energy radio waves to heat and kill the tumour cells. The procedure is usually image-guided, performed by inserting a needle-like probe (through which electric current is passed) through the skin to reach the tumour. RFA is recommended for small tumours near the edge of the lungs.

III. Radiation therapy

During radiation therapy, high energy waves such as X-rays are focused to particular parts of the lung to kill cancerous cells. It is often accompanied with chemotherapy or is performed before or after surgery.

IV. Chemotherapy

Chemotherapeutic drugs are either ingested orally or administered intravenously. Depending on the stage of the disease chemotherapy coupled with surgery and/or radiation. Most often used chemotherapeutic drugs to treat NSCLC include Cisplatin, Carboplatin, Paclitaxel, Albumin-bound Paclitaxel, Docetaxel, Etoposide, Irinotecan, Vinblastine, Premetrexed and Gemcitabine.

V. Targeted therapy

Targeted therapy works differently from chemotherapy in that targeted drugs act specifically at targeted cells. Due to this, they have lesser and different side effects. Targeted therapy for NSCLC is recommended for advanced stages of the disease, either alone, or in combination with chemotherapy. The targets upon which this kind of therapy is usually based upon include cells with overexpression of Vascular Epidermal Growth Factor/VEGF (e.g. Bevacizumab, Ramucirumab), Epidermal Growth Factor Receptor/EGFR (e.g. Necitumumab, Erlotinib, Afatinib), cells with mutated EGFR, ALK gene (e.g. Crizotinib, Ceritinib) and BRAF gene (e.g. Dabrafenib, Trametinib).

For advanced nonsquamous NSCLC, Bevacizumab along with chemotherapy is approved in people who have not received chemotherapy for their advanced disease. Bevacizumab-based therapy is the first treatment in more than a decade to have shown a better survival benefit, compared to standard chemotherapy.

VI. Immunotherapy

Immunotherapy refers to boosting the patient’s own defense mechanism (immune system) to fight against the disease. A large subclass of this kind of therapy utilizes ‘immune checkpoint inhibitors’ - drugs that break down the internal checkpoints cancer cells impose to evade destruction. Some examples of currently used immunotherapeutic drugs are Nivolumab, Pembrolizumab, Atezolizumab and Durvalumab

Treatment Management

What measures can one take to cope with the disease?

With one’s doctor’s help, there are a few measures that can be taken up to help relieve symptoms and to generally improve one’s quality of life

Coping with the disease

  • Managing shortness of breath : Shortness of breath is a commonly felt symptom, mainly due to fluid build-up around lungs (‘pleural effusion’) or blockage of airway(s) because of the growing tumour.
    To relieve this, your doctor may drain the fluid around the lungs and even take measures to prevent it from coming back. There may be a minor surgical procedure involved in these cases. But, it is best to take courage and co-operate with your doctor for better management of the discomfort.
  • Managing pain and associated depression : Find out from your doctor where one can possibly become part of a local community or rehabilitation programme to educate oneself on effective management of pain and associated depression, if any.
  • Quit tobacco smoking : Trying to quit smoking may pose a challenging task. But, it is worth the effort. This step can definitely help control the disease to a great extent.
  • Stay active : Exercise, assisted by a physical therapist, have shown great improvement in disease management of lung cancer. Talk to your doctor to know more.
  • Eat smart : With your doctor’s help, list out food that can help relieve symptoms. There are excellent books available on this. Read and chalk out a plan that suits you best.
  • Allow friends and family to help you : If you allow, you will always find help around you. So, stay positive and don’t hesitate to reach out.
  • Talk : Find out and talk to positive individuals who are fighting advanced NSCLC. Many a times, it helps.

Abbreviations

AJCC: American Joint Committee on Cancer CT scan: Computed Tomography scan EBUS: Endobronchial ultrasound EGFR: Epidermal Growth Factor Receptor IASLC: International Association for the Study of Lung Cancer IHC: Immunohistochemistry IUAC: International Union Against Cancer NSCLC: Non-small cell lung cancer MRI scan: Magnetic resonance imaging scan PET scan: Positron emission tomography scan RFA: Radiofrequency ablation SCLC: Small Cell Lung Cancer SVC: Superior vena cava TBNA: Transbronchial needle aspiration TNM: Tumor, node, metastasis staging system VATS: Video-assisted thoracic surgery VEGF: Vascular Endothelial Growth Factor

References

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