Understanding the Latest Lung Cancer Drugs

Chemotherapy for Lung Cancer

Perhaps the best-known form of medical treatment for cancer is chemotherapy, which has been saving lives since its initial use in the 1940s. While the treatment modality has a long heritage, it also is the focus of ongoing research and innovation, with recent years seeing significant advances in terms of developing new chemotherapy agents and delivering long-established ones.

Chemotherapy medications can be taken by mouth or injected into the bloodstream. Those agents travel throughout the body to attack rapidly dividing cells, making chemotherapy effective for treating or controlling lung cancer that has metastasized (spread). However, chemotherapy may damage other non-cancerous cells, causing side effects that may include hair loss, weight loss, vulnerability to infection, easy bruising, and fatigue. Researchers continue to investigate ways to prevent side effects and minimize their impact when they do occur.

For Non-Small Cell Lung Cancer

The role of chemotherapy in treating non-small cell lung cancer (NSCLC) depends in large part on the cancer’s stage. Not all patients will need chemotherapy, although it may be recommended in several situations, including:

• Before surgery, to shrink a tumor and make it easier to remove
• After surgery, to kill any cancer cells that were left behind
• To treat more advanced cancer when surgery is not an option
• To control the growth of lung cancer that has spread outside the lung

Because chemotherapy can cause significant side effects, it often is not recommended for patients in poor health.

For Small Cell Lung Cancer

Chemotherapy is usually a component of the treatment plan for small cell lung cancer (SCLC). This is because SCLC spreads quickly and is often diagnosed when it is already in advanced stages. How chemotherapy is used typically depends on the stage:

• Limited-stage SCLC: At this stage, cancer is found only on one side of the chest. Chemotherapy is often administered with radiation therapy in an approach known as chemoradiation.
• Extensive-stage SCLC: In this setting, the cancer has spread from its point of origin to the other side of the chest and beyond. Chemotherapy is given alone or with immunotherapy; radiation therapy may also be used.

As with NSCLC, chemotherapy is not often recommended for SCLC patients in poor health.

Targeted Lung Cancer Therapies

Targeted therapy is an innovative, relatively new approach to cancer treatment. Targeted therapy drugs work by interfering with or inhibiting specific cellular processes that drive the development and spread of cancer. This makes them more precise than traditional chemotherapy. Targeted drug therapies also travel through the bloodstream to work throughout the body. They attack cells with biomarkers specific to lung cancer, sparing healthy tissue so that patients generally experience fewer side effects than they may with chemotherapy.

Most targeted therapies can’t kill lung cancer by themselves. Instead, they are used to control growth. Oncologists often prescribe targeted therapies to manage advanced-stage or metastatic cancer, often while other treatments are also being administered to kill cancer cells directly. In addition, targeted therapies are typically only used for NSCLC. This is because SCLCs are genetically unstable and prone to diverse mutations, making it difficult to identify a targeted drug that will work.

Angiogenesis Inhibitors

As lung cancer tumors grow, they create new blood vessels to keep themselves supplied with oxygen and nutrients. This process is called angiogenesis. Angiogenesis inhibitors are targeted drugs that stop the formation of new blood vessels. This starves the tumor of nourishment, preventing new growth.

Because of the way angiogenesis inhibitors work, they may cause increased bleeding or issues with wound healing. As a result, they aren’t recommended for patients who are taking blood-thinning drugs.

KRAS Inhibitors

About one in eight cases of NSCLC involves a specific change to the KRAS gene, called the KRAS G12C mutation. This mutation causes cancer cells to make abnormal KRAS proteins that help those cells grow and spread. KRAS inhibitors attach themselves to the abnormal protein. With the inhibitor attached, cancer cells can no longer use the protein to grow. This effectively stops cancer from spreading.

EGFR Inhibitors

Epidermal growth factor receptor (EGFR) is a protein found on the surface of lung cells. Under normal circumstances, EGFR helps healthy cells grow and divide. However, some NSCLC cells feature a mutation that produces too much EGFR, making them grow faster. EGFR inhibitors block the signals from EGFR that tell cells to grow. When cancer cells do not receive these biochemical “instructions” to grow, they are less likely to spread.

Like other targeted drugs, EGFR inhibitors are often used to control late-stage lung cancer. They may also be used as an additional treatment after surgery for early-stage lung cancer. In this situation, they are often used in combination with chemotherapy.

ALK Inhibitors

Some NSCLC tumors have a mutation in a gene called ALK. The mutated gene produces an abnormal ALK protein that causes cell growth. ALK inhibitors attach themselves to the abnormal protein to interfere with cell growth. ALK inhibitors are often effective for:

• Patients who don’t smoke
• Young patients
• Adenocarcinomas, meaning lung cancers that form in the glandular structures of epithelial tissues in the lung

ROS1 Inhibitors

A small percentage of NSCLC tumors have a mutation in a gene called ROS1, which can be targeted with a ROS1 inhibitor. Inhibitors for this gene sometimes also work for ALK genes. In addition, ROS1 mutations are most often seen in tumors that don’t have the ALK, KRAS, or EGFR mutations. This makes this medication an effective choice when many others may fail.

HER2 Inhibitors

A minority of cases of NSCLC involve tumors with changes in the HER2 gene, which helps govern cell growth. HER2-inhibiting drugs attack cells with this change. The most frequently used HER2 inhibitors are produced with a lab-made antibody. The antibody is then linked to a chemotherapy drug. The antibody serves as a messenger that carries chemotherapy directly to the cancer cells.

HER2 mutations are also commonly found in breast cancer, making this treatment effective for both cancer types.

Other Gene Inhibitors

A wide variety of other gene and protein inhibitors may also be used in lung cancer treatment. Examples include:

• RET inhibitors
• MET inhibitors
• TRK inhibitors

Immunotherapies for Lung Cancer

Immunotherapy harnesses the power of a person’s own immune system to identify and fight cancer. Several immunotherapies play a role in treating lung cancer, including:

• Immune checkpoint inhibitors. Proteins on the surfaces of immune cells interact with proteins in other cells in a way that either triggers or tempers an immune response. Think of a soldier at his post in the middle of the night hearing someone approach in the dark. He demands that the unseen party provide the right password. If the person does, he can pass by unhindered. But if he does not give a password or offers the wrong password, the soldier perceives a threat and sounds the alarm, summoning reinforcements. The immune system’s equivalent of this “checkpoint” approach generally works well in identifying and protecting us from harmful bacteria, viruses, and other foreign substances, as well as from cancer. However, some cancers evade recognition by interacting with checkpoints in a way that prompts watchdog immune cells to tell other immune cells to “stand down” because no threat is present. Drugs called checkpoint inhibitors stop those cells from giving the “all clear” signal to the rest of the immune system, enabling cancer cells to be recognized and attacked. Immune checkpoint inhibitors used to treat NSCLC include:
  • PD-1/PD-LI inhibitors
  • CTLA-4 inhibitors

While immunotherapies typically are better tolerated than chemotherapy, they still can cause adverse effects, some of which can be significant. These include fatigue, rash, nausea, diarrhea, constipation, joint pain, and susceptibility to infection, as well as infusion reactions such as fever, chills, and trouble breathing.

While oncologists now have a wide variety of options for treating lung cancer, Researchers are developing even more therapies. To further this effort and to give our patients access to the latest advances in cancer care, RCCA offers access to clinical trials. These studies allow patients to participate in cutting-edge studies into new treatments that may save lives.

Learn More About Lung Cancer Treatment at RCCA

Regional Cancer Care Associates is committed to offering our patients the most advanced and effective lung cancer medications. We offer treatment at over 20 locations in New Jersey, Connecticut, Massachusetts, Maryland, and the Washington, D.C., area, enabling patients to receive care close to home. Our experts specialize in a wide variety of cancer types and blood disorders. Contact us today to learn more about our targeted therapies and other treatment options for lung cancer.