Chemotherapy to Treat Lung Cancer

Chemotherapy is highly individualized and may involve taking a combination of several drugs given in four to six cycles. The drug cisplatin (Platinol) used to be the standard treatment for non-small cell lung cancer. Now a second drug, such as gemcitabine (Gemzar), vinorelbine (Navelbine), paclitaxel (Taxol), or docetaxel (Taxotere), is added to boost cisplatin's effectiveness. Sometimes a less toxic drug called carboplatin (Paraplatin) is substituted for cisplatin.

Like most chemotherapy regimens, these combinations usually cause temporary but severe side effects that may include

  • nausea
  • vomiting
  • loss of appetite
  • hair loss
  • mouth sores
  • severe diarrhea
  • fatigue
  • low resistance to infection

The search continues for better alternatives, and researchers are making some progress. For example, erlotinib (Tarceva) has been shown to modestly prolong survival in people with non-small cell lung cancer, especially in women and in people who never smoked.

It is most often used to treat advanced lung cancer if initial treatment with chemotherapy is no longer working. Tarceva targets specific molecules called epidermal growth factor receptors (EGFRs), which are known to enhance the growth of cancer, and continuing research is aimed at finding ways to predict which lung cancer patients will respond to it.

Bevacizumab (Avastin) is approved as an initial treatment against non-small cell lung cancer, in combination with chemotherapy. Avastin has been shown to prolong survival in individuals with advanced lung cancer when added to standard chemotherapy regimens as part of first-line treatment. Because Avastin can cause internal bleeding, it cannot be used in people at high risk for internal bleeding, such as patients using blood thinners.

Research suggests that combining Tarceva and Avastin improves survival compared with that of patients taking Avastin plus chemotherapy or chemotherapy alone.

The drug cetuximab (Erbitux) is used as a first-line treatment in addition to standard chemotherapy in some individuals who have advanced lung cancer. As with Tarceva, Erbitux targets EGFRs.

Permetrexed (Alimta), in combination with cisplatin, is approved as a first-line treatment for advanced nonsquamous, non-small cell lung cancer.

Cisplatin or carboplatin plus etoposide (VePesid, Etopophos) is usually considered the optimal chemotherapy regimen for small cell lung cancer, but researchers are studying other combinations. Some studies have found that combinations with less severe side effects, such as gemcitabine (Gemzar) with vinorelbine (Navelbine) or paclitaxel (Taxol) may be just as effective for many patients.

Publication Review By: Peter B. Terry, M.D., M.A.

Published: 14 Sep 2011

Last Modified: 14 Sep 2011